{"hospital_name":"Ssm Health St. Mary's Hospital -Centralia","last_updated_on":"2026-04-01","version":"3.0.0","location_name":["Ssm Health St. Mary's Hospital -Centralia"],"hospital_address":["400 North Pleasant Avenue, Centralia, IL 62801"],"license_information":{"license_number":"140034","state":"IL"},"type_2_npi":["1780763284","1962572396","1386026631","1922183888","1497937213"],"attestation":{"attestation":"To the best of its knowledge and belief, this hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date in the file. This hospital has included all payer-specific negotiated charges in dollars that can be expressed as a dollar amount. For payer-specific negotiated charges that cannot be expressed as a dollar amount in the machine-readable file or not knowable in advance, the hospital attests that the payer-specific negotiated charge is based on a contractual algorithm, percentage or formula that precludes the provision of a dollar amount and has provided all necessary information available to the hospital for the public to be able to derive the dollar amount, including, but not limited to, the specific fee schedule or components referenced in such percentage, algorithm or formula.","confirm_attestation":true,"attester_name":"John Snodsmith "},"modifier_information":[{"description":"Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities","code":"TC","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Coventry/Non Gatekeeper PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Community Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthlink","plan_name":"Open Access HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthlink","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Mine Works of America","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VACCN Government","description":"The modified price is presented in the standard charge value."}]}],"standard_charge_information":[{"description":"Digestive Malignancy With Mcc","code_information":[{"code":"374","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17034.51,"maximum":39161.99,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17886.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39161.99},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":17034.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17034.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17715.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":17034.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 70.85] [All Other IP (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Digestive Malignancy With Cc","code_information":[{"code":"375","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9842.41,"maximum":22788.7,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10334.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22788.7},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":9842.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9842.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10236.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":9842.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 70.85] [All Other IP (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Digestive Malignancy Without Cc/Mcc","code_information":[{"code":"376","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7633.92,"maximum":16375.15,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8015.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16375.15},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":7633.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7633.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7939.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":7633.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 70.85] [All Other IP (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Hemorrhage With Mcc","code_information":[{"code":"377","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14629.41,"maximum":33720.3,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15360.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33720.3},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":14629.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14629.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15214.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":14629.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 70.85] [All Other IP (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"1 through 10","median_amount":27897.34,"10th_percentile":27897.34,"90th_percentile":27897.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14882.1,"10th_percentile":14882.1,"90th_percentile":15230.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Hemorrhage With Cc","code_information":[{"code":"378","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8070.51,"maximum":18285.49,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8474.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18285.49},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":8070.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8070.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8393.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":8070.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8487.68,"10th_percentile":8487.68,"90th_percentile":8487.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Gastrointestinal Hemorrhage Without Cc/Mcc","code_information":[{"code":"379","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5358.86,"maximum":11807.02,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5626.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11807.02},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":5358.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5358.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5573.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":5358.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammatory Bowel Disease Without Cc/Mcc","code_information":[{"code":"387","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5752.88,"maximum":12432.05,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6040.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12432.05},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":5752.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5752.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5983.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":5752.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5871.14,"10th_percentile":5871.14,"90th_percentile":5871.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Gastrointestinal Obstruction With Mcc","code_information":[{"code":"388","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11910.79,"maximum":27264.09,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12506.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27264.09},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":11910.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11910.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12387.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":11910.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":8948.81,"10th_percentile":8948.81,"90th_percentile":8948.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Obstruction With Cc","code_information":[{"code":"389","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6592.77,"maximum":14869.13,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6922.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14869.13},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":6592.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6592.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6856.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":6592.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":6472.88,"10th_percentile":6472.88,"90th_percentile":6472.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6544.02,"10th_percentile":6544.02,"90th_percentile":6544.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6976.26,"10th_percentile":6976.26,"90th_percentile":6976.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Gastrointestinal Obstruction Without Cc/Mcc","code_information":[{"code":"390","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4690.05,"maximum":10147.06,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4924.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10147.06},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":4690.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4690.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4877.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":4690.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"1 through 10","median_amount":16451.07,"10th_percentile":16451.07,"90th_percentile":16451.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Other Digestive System Diagnoses With Mcc","code_information":[{"code":"393","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12859.05,"maximum":30711.98,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13502.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30711.98},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":12859.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12859.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13373.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":12859.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System Diagnoses With Cc","code_information":[{"code":"394","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7722.17,"maximum":17458.29,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8108.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17458.29},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":7722.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7722.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8031.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":7722.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2873.86,"10th_percentile":2873.86,"90th_percentile":2873.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 70.85] [All Other IP (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6288.92,"10th_percentile":6288.92,"90th_percentile":6288.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6827.87,"10th_percentile":6827.87,"90th_percentile":6827.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System Diagnoses Without Cc/Mcc","code_information":[{"code":"395","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5502.85,"maximum":11803.31,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5777.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11803.31},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":5502.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5502.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5722.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":5502.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 70.85] [All Other IP (%BC): 70.85]","count":"1 through 10","median_amount":26365.67,"10th_percentile":26365.67,"90th_percentile":26365.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendix Procedures With Mcc","code_information":[{"code":"397","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19017.74,"maximum":45952.05,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19968.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45952.05},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":19017.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19017.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19778.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":19017.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 70.85] [All Other IP (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendix Procedures With Cc","code_information":[{"code":"398","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12195.66,"maximum":28067.18,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12805.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28067.18},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":12195.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12195.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12683.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":12195.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 70.85] [All Other IP (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendix Procedures Without Cc/Mcc","code_information":[{"code":"399","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9340.03,"maximum":20848.68,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9807.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20848.68},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":9340.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9340.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9713.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":9340.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"1 through 10","median_amount":43714.52,"10th_percentile":43714.52,"90th_percentile":43714.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical","code_information":[{"code":"402","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31601.4,"maximum":72874.87,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33181.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72874.87},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":31601.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31601.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32865.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":31601.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System O.R. Procedures Without Cc/Mcc","code_information":[{"code":"358","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11300.03,"maximum":25131.19,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11865.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25131.19},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":11300.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11300.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11752.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":11300.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System O.R. Procedures With Cc","code_information":[{"code":"357","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18480.52,"maximum":41765.99,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19404.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41765.99},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":18480.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18480.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19219.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":18480.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Procedures With Mcc","code_information":[{"code":"356","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":34483.35,"maximum":79110.37,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36207.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":79110.37},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":34483.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34483.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35862.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":34483.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc","code_information":[{"code":"355","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10890.53,"maximum":24725.01,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11435.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24725.01},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":10890.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10890.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11326.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":10890.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Major Small And Large Bowel Procedures With Mcc","code_information":[{"code":"329","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":36060.18,"maximum":85162.26,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37863.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":85162.26},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":36060.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36060.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37502.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":36060.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal And Duodenal Procedures With Cc","code_information":[{"code":"327","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19399.37,"maximum":45033.97,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20369.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45033.97},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":19399.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19399.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20175.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":19399.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18502.38,"10th_percentile":18502.38,"90th_percentile":18502.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal And Duodenal Procedures With Mcc","code_information":[{"code":"326","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":39086.11,"maximum":94194.65,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41040.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":94194.65},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":39086.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39086.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40649.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":39086.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc","code_information":[{"code":"322","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14126.24,"maximum":33553.38,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14832.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33553.38},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":14126.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14126.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14691.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":14126.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concomitant Left Atrial Appendage Closure And Cardiac Ablation","code_information":[{"code":"317","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":52238.73,"maximum":114731.74,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54850.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":114731.74},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":52238.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52238.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54328.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":52238.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System Diagnoses Without Cc/Mcc","code_information":[{"code":"316","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5759.07,"maximum":12660.18,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6047.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12660.18},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":5759.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5759.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5989.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":5759.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 70.85] [All Other IP (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System Diagnoses With Cc","code_information":[{"code":"315","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7935.82,"maximum":17847.78,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8332.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17847.78},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":7935.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7935.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":7935.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2806.1,"10th_percentile":2806.1,"90th_percentile":2806.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System Diagnoses With Mcc","code_information":[{"code":"314","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16620.37,"maximum":39939.11,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17451.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39939.11},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":16620.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16620.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17285.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":16620.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17423.63,"10th_percentile":17423.63,"90th_percentile":17423.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Chest Pain","code_information":[{"code":"313","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6052.45,"maximum":13229.58,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6355.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13229.58},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":6052.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6052.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6294.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":6052.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Syncope And Collapse","code_information":[{"code":"312","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7225.98,"maximum":16160.0,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7587.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16160.0},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":7225.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7225.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7515.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":7225.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"1 through 10","median_amount":26093.11,"10th_percentile":26093.11,"90th_percentile":29558.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Angina Pectoris","code_information":[{"code":"311","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5912.34,"maximum":12955.08,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6207.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12955.08},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":5912.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5912.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6148.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":5912.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":645.19,"10th_percentile":645.19,"90th_percentile":645.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10085.6,"10th_percentile":10085.6,"90th_percentile":10085.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Atherosclerosis Without Mcc","code_information":[{"code":"303","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5690.18,"maximum":12471.0,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5974.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12471.0},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":5690.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5690.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5917.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":5690.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral Vascular Disorders With Mcc","code_information":[{"code":"299","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13117.6,"maximum":30003.48,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13773.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30003.48},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":13117.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13117.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13642.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":13117.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"21","median_amount":9558.71,"10th_percentile":6319.1,"90th_percentile":11166.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11191.28,"10th_percentile":10433.64,"90th_percentile":11270.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Acute And Subacute Endocarditis Without Cc/Mcc","code_information":[{"code":"290","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7675.73,"maximum":18157.51,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8059.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18157.51},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":7675.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7675.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7982.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":7675.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11913.93,"10th_percentile":11913.93,"90th_percentile":11913.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without Mcc","code_information":[{"code":"279","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28395.88,"maximum":59428.3,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29815.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59428.3},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":28395.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28395.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29531.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":28395.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22896.07,"10th_percentile":22896.07,"90th_percentile":22896.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Respiratory System Diagnosis With Ventilator Support >96 Hours","code_information":[{"code":"207","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":50289.56,"maximum":119956.43,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52804.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":119956.43},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":50289.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50289.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52301.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":50289.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bronchitis And Asthma With Cc/Mcc","code_information":[{"code":"202","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7996.97,"maximum":17929.38,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8396.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17929.38},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":7996.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7996.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8316.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":7996.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Pneumothorax Without Cc/Mcc","code_information":[{"code":"201","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6014.52,"maximum":12554.46,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6315.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12554.46},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":6014.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6014.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6255.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":6014.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":7421.03,"10th_percentile":7421.03,"90th_percentile":7421.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4972.8,"10th_percentile":4972.8,"90th_percentile":4972.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simple Pneumonia And Pleurisy With Cc","code_information":[{"code":"194","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6717.4,"maximum":15208.54,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7053.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15208.54},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":6717.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6717.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6986.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":6717.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 70.85] [All Other IP (%BC): 70.85]","count":"1 through 10","median_amount":14026.32,"10th_percentile":14026.32,"90th_percentile":14026.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"1 through 10","median_amount":13449.45,"10th_percentile":13449.45,"90th_percentile":13449.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":4697.3,"10th_percentile":1087.62,"90th_percentile":9013.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1034.29,"10th_percentile":1034.29,"90th_percentile":1034.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"11","median_amount":5647.65,"10th_percentile":296.39,"90th_percentile":7039.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7127.79,"10th_percentile":7122.52,"90th_percentile":7127.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Simple Pneumonia And Pleurisy With Mcc","code_information":[{"code":"193","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10653.66,"maximum":24441.24,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11186.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24441.24},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":10653.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10653.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11079.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":10653.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"1 through 10","median_amount":32283.09,"10th_percentile":32283.09,"90th_percentile":32649.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"1 through 10","median_amount":17078.1,"10th_percentile":17078.1,"90th_percentile":17078.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":9520.39,"10th_percentile":9520.39,"90th_percentile":9520.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":9240.99,"10th_percentile":9240.99,"90th_percentile":9240.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"20","median_amount":9215.09,"10th_percentile":4978.99,"90th_percentile":11988.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11300.99,"10th_percentile":11300.99,"90th_percentile":11300.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Chronic Obstructive Pulmonary Disease Without Cc/Mcc","code_information":[{"code":"192","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5448.66,"maximum":12003.62,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5721.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12003.62},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":5448.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5448.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5666.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":5448.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5104.42,"10th_percentile":5104.42,"90th_percentile":5104.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5704.73,"10th_percentile":5704.73,"90th_percentile":5704.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Chronic Obstructive Pulmonary Disease With Cc","code_information":[{"code":"191","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7004.59,"maximum":15933.73,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7354.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15933.73},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":7004.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7004.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7284.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":7004.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6927.63,"10th_percentile":6927.63,"90th_percentile":6927.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Chronic Obstructive Pulmonary Disease With Mcc","code_information":[{"code":"190","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9053.61,"maximum":20833.85,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9506.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20833.85},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":9053.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9053.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9415.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":9053.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9645.03,"10th_percentile":9645.03,"90th_percentile":9645.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Pulmonary Edema And Respiratory Failure","code_information":[{"code":"189","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10042.13,"maximum":22951.91,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10544.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22951.91},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":10042.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10042.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10443.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":10042.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":4791.54,"10th_percentile":4791.54,"90th_percentile":4791.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"1 through 10","median_amount":20701.16,"10th_percentile":20701.16,"90th_percentile":20701.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":8227.62,"10th_percentile":513.28,"90th_percentile":10584.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":8533.11,"10th_percentile":8533.11,"90th_percentile":8533.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"14","median_amount":9436.53,"10th_percentile":349.51,"90th_percentile":9937.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10618.02,"10th_percentile":10618.02,"90th_percentile":10618.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Pleural Effusion Without Cc/Mcc","code_information":[{"code":"188","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6030.78,"maximum":13615.35,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6332.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13615.35},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":6030.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6030.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6272.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":6030.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7565.37,"10th_percentile":7565.37,"90th_percentile":7565.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Trauma With Mcc","code_information":[{"code":"183","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12321.83,"maximum":29437.8,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12937.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29437.8},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":12321.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12321.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12814.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":12321.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Neoplasms With Cc","code_information":[{"code":"181","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8769.52,"maximum":20590.88,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9208.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20590.88},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":8769.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8769.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9120.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":8769.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Neoplasms With Mcc","code_information":[{"code":"180","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14149.47,"maximum":32414.59,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14856.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32414.59},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":14149.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14149.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14715.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":14149.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Infections And Inflammations With Cc","code_information":[{"code":"178","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8034.13,"maximum":18400.48,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8435.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18400.48},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":8034.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8034.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8355.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":8034.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Infections And Inflammations With Mcc","code_information":[{"code":"177","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12575.74,"maximum":29981.23,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13204.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29981.23},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":12575.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12575.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13078.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":12575.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13827.98,"10th_percentile":13827.98,"90th_percentile":13827.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Pulmonary Embolism Without Mcc","code_information":[{"code":"176","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6710.43,"maximum":15106.53,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7045.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15106.53},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":6710.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6710.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6978.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":6710.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pulmonary Embolism With Mcc Or Acute Cor Pulmonale","code_information":[{"code":"175","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11111.93,"maximum":26134.58,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11667.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26134.58},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":11111.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11111.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11556.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":11111.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Otitis Media And Uri Without Mcc","code_information":[{"code":"153","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6193.34,"maximum":13199.9,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6503.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13199.9},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":6193.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6193.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6441.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":6193.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Otitis Media And Uri With Mcc","code_information":[{"code":"152","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9630.31,"maximum":21045.28,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10111.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21045.28},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":9630.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9630.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10015.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":9630.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":906.6,"10th_percentile":906.6,"90th_percentile":906.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6989.42,"10th_percentile":6989.42,"90th_percentile":6989.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Acute Major Eye Infections Without Cc/Mcc","code_information":[{"code":"122","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6561.8,"maximum":12580.43,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6889.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12580.43},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":6561.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6561.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6824.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":6561.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Major Eye Infections With Cc/Mcc","code_information":[{"code":"121","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9484.01,"maximum":21572.02,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9958.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21572.02},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":9484.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9484.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9863.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":9484.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":6501.69,"10th_percentile":6501.69,"90th_percentile":6501.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc","code_information":[{"code":"099","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11025.23,"maximum":25839.68,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11576.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25839.68},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":11025.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11025.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11466.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":11025.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Mcc","code_information":[{"code":"097","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28437.68,"maximum":66487.29,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29859.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66487.29},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":28437.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28437.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29575.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":28437.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23719.45,"10th_percentile":23719.45,"90th_percentile":23719.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc","code_information":[{"code":"096","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20444.39,"maximum":44457.16,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21466.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44457.16},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":20444.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20444.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21262.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":20444.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bacterial And Tuberculous Infections Of Nervous System With Cc","code_information":[{"code":"095","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20444.39,"maximum":44457.16,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21466.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44457.16},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":20444.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20444.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21262.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":20444.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of Nervous System Without Cc/Mcc","code_information":[{"code":"093","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6643.08,"maximum":14639.15,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6975.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14639.15},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":6643.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6643.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6908.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":6643.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 70.85] [All Other IP (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5405.78,"10th_percentile":5405.78,"90th_percentile":5405.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of Nervous System With Cc","code_information":[{"code":"092","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8397.95,"maximum":19637.56,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8817.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19637.56},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":8397.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8397.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8733.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":8397.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 70.85] [All Other IP (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":275.99,"10th_percentile":275.99,"90th_percentile":275.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of Nervous System With Mcc","code_information":[{"code":"091","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14073.61,"maximum":33807.47,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14777.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33807.47},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":14073.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14073.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14636.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":14073.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 70.85] [All Other IP (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14821.15,"10th_percentile":14821.15,"90th_percentile":14821.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concussion Without Cc/Mcc","code_information":[{"code":"090","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6851.32,"maximum":15898.49,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7193.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15898.49},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":6851.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6851.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7125.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":6851.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 70.85] [All Other IP (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nontraumatic Stupor And Coma Without Mcc","code_information":[{"code":"081","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7411.76,"maximum":16781.33,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7782.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16781.33},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":7411.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7411.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7708.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":7411.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cranial And Peripheral Nerve Disorders With Mcc","code_information":[{"code":"073","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12897.76,"maximum":28664.39,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13542.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28664.39},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":12897.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12897.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13413.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":12897.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cerebrovascular Disorders Without Cc/Mcc","code_information":[{"code":"072","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6332.67,"maximum":13912.1,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6649.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13912.1},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":6332.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6332.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6585.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":6332.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 70.85] [All Other IP (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cerebrovascular Disorders With Cc","code_information":[{"code":"071","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8421.18,"maximum":19544.83,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8842.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19544.83},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":8421.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8421.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8758.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":8421.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 70.85] [All Other IP (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6795.34,"10th_percentile":6795.34,"90th_percentile":6795.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cerebrovascular Disorders With Mcc","code_information":[{"code":"070","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13366.08,"maximum":32247.67,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14034.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32247.67},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":13366.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13366.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13900.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":13366.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 70.85] [All Other IP (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13590.78,"10th_percentile":13590.78,"90th_percentile":13590.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transient Ischemia Without Thrombolytic","code_information":[{"code":"069","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6662.44,"maximum":14841.31,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6995.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14841.31},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":6662.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6662.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6928.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":6662.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 70.85] [All Other IP (%BC): 70.85]","count":"1 through 10","median_amount":20988.29,"10th_percentile":20988.29,"90th_percentile":20988.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":6238.55,"10th_percentile":6238.55,"90th_percentile":6238.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6137.83,"10th_percentile":6137.83,"90th_percentile":6457.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Precerebral Occlusion Without Infarction Without Mcc","code_information":[{"code":"068","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7170.24,"maximum":16351.04,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7528.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16351.04},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":7170.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7170.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7457.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":7170.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours","code_information":[{"code":"065","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8299.64,"maximum":18862.3,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8714.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18862.3},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":8299.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8299.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8631.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":8299.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7063.35,"10th_percentile":7063.35,"90th_percentile":7063.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction With Mcc","code_information":[{"code":"064","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16046.0,"maximum":36891.84,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16848.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36891.84},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":16046.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16046.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16687.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":16046.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc","code_information":[{"code":"060","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7599.09,"maximum":16551.34,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7979.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16551.34},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":7599.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7599.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7903.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":7599.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Sclerosis And Cerebellar Ataxia With Cc","code_information":[{"code":"059","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10084.7,"maximum":22692.25,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10588.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22692.25},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":10084.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10084.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10488.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":10084.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Sclerosis And Cerebellar Ataxia With Mcc","code_information":[{"code":"058","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13712.1,"maximum":34232.2,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14397.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34232.2},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":13712.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13712.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14260.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":13712.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1538.24,"10th_percentile":452.88,"90th_percentile":11425.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10389.86,"10th_percentile":10389.86,"90th_percentile":10389.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Degenerative Nervous System Disorders With Mcc","code_information":[{"code":"056","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18461.94,"maximum":46441.69,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19385.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46441.69},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":18461.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18461.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19200.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":18461.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":10092.9,"10th_percentile":10092.9,"90th_percentile":10092.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc","code_information":[{"code":"267","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":37332.01,"maximum":87252.51,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39198.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":87252.51},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":37332.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37332.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38825.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":37332.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Procedures","code_information":[{"code":"264","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26338.34,"maximum":64819.91,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27655.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64819.91},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":26338.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26338.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27391.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":26338.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vein Ligation And Stripping","code_information":[{"code":"263","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24146.11,"maximum":49741.2,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25353.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49741.2},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":24146.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24146.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25111.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":24146.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":23953.55,"10th_percentile":23953.55,"90th_percentile":23953.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Vascular Procedures Without Cc/Mcc","code_information":[{"code":"254","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14271.0,"maximum":32444.27,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14984.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32444.27},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":14271.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14271.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14841.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":14271.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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With Mcc","code_information":[{"code":"414","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28056.83,"maximum":64981.27,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29459.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64981.27},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":28056.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28056.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29179.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":28056.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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With Cc","code_information":[{"code":"415","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16477.17,"maximum":36685.97,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17301.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36685.97},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":16477.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16477.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17136.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":16477.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Laparoscopic Cholecystectomy Without C.D.E. With Mcc","code_information":[{"code":"417","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18951.94,"maximum":44076.95,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19899.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44076.95},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":18951.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18951.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19710.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":18951.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20224.98,"10th_percentile":20224.98,"90th_percentile":20224.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Laparoscopic Cholecystectomy Without C.D.E. With Cc","code_information":[{"code":"418","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13573.54,"maximum":30760.2,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14252.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30760.2},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":13573.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13573.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14116.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":13573.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11300.15,"10th_percentile":11300.15,"90th_percentile":11300.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Hepatobiliary Diagnostic Procedures With Mcc","code_information":[{"code":"420","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26853.11,"maximum":65456.07,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28195.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65456.07},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":26853.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26853.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27927.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":26853.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Mcc Or Custom-Made","code_information":[{"code":"426","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":85793.35,"maximum":194402.24,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90083.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194402.24},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":85793.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":85793.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":89225.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":85793.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":95279.16,"10th_percentile":95279.16,"90th_percentile":95279.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Cc","code_information":[{"code":"427","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":56357.68,"maximum":131659.59,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59175.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":131659.59},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":56357.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56357.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58611.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":56357.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Without Cc/Mcc","code_information":[{"code":"428","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":43998.5,"maximum":102104.94,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46198.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":102104.94},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":43998.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43998.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45758.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":43998.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":57359.47,"10th_percentile":57359.47,"90th_percentile":57359.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Combined Anterior And Posterior Cervical Spinal Fusion With Mcc","code_information":[{"code":"429","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":70221.69,"maximum":154681.98,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":73732.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":154681.98},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":70221.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70221.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":73030.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":70221.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Pancreas Except Malignancy With Mcc","code_information":[{"code":"438","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13098.25,"maximum":30858.5,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13753.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30858.5},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":13098.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13098.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13622.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":13098.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4364.8,"10th_percentile":4364.8,"90th_percentile":4364.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Pancreas Except Malignancy With Cc","code_information":[{"code":"439","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6990.65,"maximum":15954.13,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7340.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15954.13},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":6990.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6990.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7270.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":6990.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc","code_information":[{"code":"443","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5895.31,"maximum":13031.12,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6190.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13031.12},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":5895.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5895.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6131.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":5895.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of The Biliary Tract With Mcc","code_information":[{"code":"444","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13413.3,"maximum":31242.42,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14083.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31242.42},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":13413.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13413.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13949.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":13413.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of The Biliary Tract With Cc","code_information":[{"code":"445","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8950.66,"maximum":20112.37,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9398.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20112.37},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":8950.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8950.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9308.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":8950.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of The Biliary Tract Without Cc/Mcc","code_information":[{"code":"446","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6883.05,"maximum":14785.67,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14785.67},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":6883.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6883.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7158.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":6883.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody","code_information":[{"code":"447","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":52200.8,"maximum":124342.8,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54810.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":124342.8},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":52200.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52200.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54288.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":52200.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26340.72,"10th_percentile":26340.72,"90th_percentile":26340.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","code_information":[{"code":"456","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":65529.13,"maximum":157067.12,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":68805.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":157067.12},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":65529.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65529.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":68150.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":65529.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25336.74,"10th_percentile":25336.74,"90th_percentile":25336.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24730.28,"10th_percentile":24730.28,"90th_percentile":24730.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Cervical Spinal Fusion Without Cc/Mcc","code_information":[{"code":"473","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19376.92,"maximum":43904.46,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20345.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43904.46},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":19376.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19376.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20152.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":19376.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biopsies Of Musculoskeletal System And Connective Tissue With Cc","code_information":[{"code":"478","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19515.48,"maximum":43370.3,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20491.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43370.3},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":19515.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19515.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20296.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":19515.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Hip And Femur Procedures Except Major Joint With Cc","code_information":[{"code":"481","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16692.36,"maximum":38483.17,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17526.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38483.17},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":16692.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16692.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17360.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":16692.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip And Femur Procedures Except Major Joint Without Cc/Mcc","code_information":[{"code":"482","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13104.44,"maximum":29422.96,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13759.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29422.96},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":13104.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13104.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13628.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":13104.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Joint Or Limb Reattachment Procedures Of Upper Extremities","code_information":[{"code":"483","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21936.07,"maximum":47259.61,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23032.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47259.61},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":21936.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21936.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22813.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":21936.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures With Principal Diagnosis Of Infection Without Cc/Mcc","code_information":[{"code":"487","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12602.83,"maximum":29306.11,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13232.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29306.11},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":12602.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12602.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13106.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":12602.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Foot Procedures Without Cc/Mcc","code_information":[{"code":"505","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14356.92,"maximum":32561.11,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15074.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32561.11},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":14356.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14356.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14931.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":14356.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue O.R. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurostimulator","code_information":[{"code":"518","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29409.17,"maximum":66468.74,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30879.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66468.74},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":29409.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29409.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30585.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":29409.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 70.85] [All Other IP (%BC): 70.85]","count":"1 through 10","median_amount":92028.01,"10th_percentile":92028.01,"90th_percentile":92028.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back And Neck Procedures Except Spinal Fusion With Cc","code_information":[{"code":"519","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15962.39,"maximum":36569.12,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16760.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36569.12},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":15962.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15962.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16600.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":15962.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 70.85] [All Other IP (%BC): 70.85]","count":"1 through 10","median_amount":73709.36,"10th_percentile":73709.36,"90th_percentile":73709.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc","code_information":[{"code":"520","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12043.16,"maximum":26579.71,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12645.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26579.71},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":12043.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12043.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12524.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":12043.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc","code_information":[{"code":"521","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22697.01,"maximum":54057.09,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23831.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54057.09},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":22697.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22697.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23604.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":22697.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/Mcc","code_information":[{"code":"537","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7866.15,"maximum":17042.84,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8259.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17042.84},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":7866.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7866.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8180.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":7866.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Connective Tissue Disorders Without Cc/Mcc","code_information":[{"code":"547","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6951.95,"maximum":13839.77,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7299.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13839.77},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":6951.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6951.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7230.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":6951.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":662.5,"10th_percentile":662.5,"90th_percentile":662.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 70.85] [All Other IP (%BC): 70.85]","count":"1 through 10","median_amount":18820.04,"10th_percentile":18820.04,"90th_percentile":18820.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8312.03,"10th_percentile":8312.03,"90th_percentile":8312.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Bone Diseases And Arthropathies With Mcc","code_information":[{"code":"553","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10513.55,"maximum":24227.95,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11039.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24227.95},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":10513.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10513.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10934.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":10513.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tendonitis, Myositis And Bursitis With Mcc","code_information":[{"code":"557","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11988.97,"maximum":28742.29,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12588.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28742.29},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":11988.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11988.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12468.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":11988.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare, Musculoskeletal System And Connective Tissue With Mcc","code_information":[{"code":"559","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14915.05,"maximum":34425.09,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15660.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34425.09},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":14915.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14915.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15511.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":14915.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":4967.74,"10th_percentile":4967.74,"90th_percentile":4967.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc","code_information":[{"code":"561","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6701.92,"maximum":15164.03,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7037.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15164.03},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":6701.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6701.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6970.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":6701.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 70.85] [All Other IP (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With Mcc","code_information":[{"code":"562","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11508.26,"maximum":27147.24,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12083.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27147.24},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":11508.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11508.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11968.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":11508.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12654.2,"10th_percentile":12654.2,"90th_percentile":12654.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11378.21,"10th_percentile":11378.21,"90th_percentile":11378.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc","code_information":[{"code":"563","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7410.99,"maximum":16575.45,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7781.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16575.45},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":7410.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7410.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7707.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":7410.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 70.85] [All Other IP (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1518.16,"10th_percentile":1518.16,"90th_percentile":1518.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1761.15,"10th_percentile":1761.15,"90th_percentile":1761.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc","code_information":[{"code":"564","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12427.88,"maximum":29103.95,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13049.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29103.95},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":12427.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12427.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12925.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":12427.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 70.85] [All Other IP (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12286.99,"10th_percentile":12286.99,"90th_percentile":12286.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue Diagnoses With Cc","code_information":[{"code":"565","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8021.74,"maximum":18910.52,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8422.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18910.52},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":8021.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8021.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8342.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":8021.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":8865.83,"10th_percentile":8865.83,"90th_percentile":8865.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 70.85] [All Other IP (%BC): 70.85]","count":"1 through 10","median_amount":11826.49,"10th_percentile":11826.49,"90th_percentile":11826.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8610.24,"10th_percentile":8610.24,"90th_percentile":8610.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc","code_information":[{"code":"566","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6279.26,"maximum":13873.16,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6593.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13873.16},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":6279.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6279.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6530.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":6279.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 70.85] [All Other IP (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Debridement With Mcc","code_information":[{"code":"570","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23245.84,"maximum":55833.89,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24408.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55833.89},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":23245.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23245.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24175.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":23245.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 70.85] [All Other IP (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Debridement With Cc","code_information":[{"code":"571","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13557.29,"maximum":31062.52,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14235.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31062.52},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":13557.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13557.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14099.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":13557.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":11088.82,"10th_percentile":11088.82,"90th_percentile":11088.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12758.71,"10th_percentile":12758.71,"90th_percentile":12758.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Debridement Without Cc/Mcc","code_information":[{"code":"572","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9352.41,"maximum":21188.09,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9820.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21188.09},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":9352.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9352.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9726.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":9352.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"1 through 10","median_amount":8811.03,"10th_percentile":8811.03,"90th_percentile":8811.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":11939.02,"10th_percentile":11939.02,"90th_percentile":11939.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Cellulitis Without Mcc","code_information":[{"code":"603","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7220.56,"maximum":16338.05,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7581.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16338.05},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":7220.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7220.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7509.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":7220.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":6164.7,"10th_percentile":4829.36,"90th_percentile":8950.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7761.04,"10th_percentile":7761.04,"90th_percentile":7761.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc","code_information":[{"code":"604","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11874.41,"maximum":27555.28,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12468.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27555.28},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":11874.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11874.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12349.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":11874.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc","code_information":[{"code":"605","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7569.67,"maximum":17131.86,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7948.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17131.86},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":7569.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7569.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7872.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":7569.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Skin Disorders With Mcc","code_information":[{"code":"606","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12192.56,"maximum":29862.52,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12802.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29862.52},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":12192.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12192.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12680.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":12192.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","code_information":[{"code":"618","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11457.94,"maximum":23091.02,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12030.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23091.02},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":11457.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11457.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11916.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":11457.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","code_information":[{"code":"624","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10169.85,"maximum":18604.5,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10678.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18604.5},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":10169.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10169.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10576.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":10169.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Diabetes With Cc","code_information":[{"code":"638","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7416.4,"maximum":17011.31,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7787.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17011.31},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":7416.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7416.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7713.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":7416.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5779.59,"10th_percentile":5779.59,"90th_percentile":5779.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"1 through 10","median_amount":5338.02,"10th_percentile":5338.02,"90th_percentile":5338.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7475.43,"10th_percentile":294.19,"90th_percentile":8074.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Diabetes Without Cc/Mcc","code_information":[{"code":"639","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5287.65,"maximum":11621.55,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5552.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11621.55},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":5287.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5287.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5499.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":5287.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":564.42,"10th_percentile":564.42,"90th_percentile":564.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc","code_information":[{"code":"640","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10817.77,"maximum":24632.27,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11358.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24632.27},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":10817.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10817.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11250.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":10817.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc","code_information":[{"code":"641","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6502.97,"maximum":14494.48,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6828.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14494.48},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":6502.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6502.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6763.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":6502.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":6919.85,"10th_percentile":6919.85,"90th_percentile":6919.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"1 through 10","median_amount":8351.14,"10th_percentile":8351.14,"90th_percentile":8351.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5481.43,"10th_percentile":5481.43,"90th_percentile":6976.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Inborn And Other Disorders Of Metabolism","code_information":[{"code":"642","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11487.36,"maximum":23018.68,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12061.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23018.68},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":11487.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11487.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11946.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":11487.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Procedures With Cc","code_information":[{"code":"674","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18581.93,"maximum":42812.04,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19511.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42812.04},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":18581.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18581.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19325.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":18581.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Procedures Without Cc/Mcc","code_information":[{"code":"675","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13184.95,"maximum":29029.76,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13844.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29029.76},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":13184.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13184.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13712.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":13184.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 70.85] [All Other IP (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Renal Failure With Mcc","code_information":[{"code":"682","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11943.3,"maximum":27857.59,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12540.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27857.59},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":11943.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11943.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12421.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":11943.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 70.85] [All Other IP (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":4855.02,"10th_percentile":4855.02,"90th_percentile":4855.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Renal Failure With Cc","code_information":[{"code":"683","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7258.49,"maximum":16486.43,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7621.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16486.43},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":7258.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7258.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7548.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":7258.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 70.85] [All Other IP (%BC): 70.85]","count":"1 through 10","median_amount":12881.01,"10th_percentile":12881.01,"90th_percentile":12881.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5038.36,"10th_percentile":5038.36,"90th_percentile":5038.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5271.31,"10th_percentile":296.69,"90th_percentile":7664.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Renal Failure Without Cc/Mcc","code_information":[{"code":"684","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5125.86,"maximum":11267.3,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5382.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11267.3},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":5125.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5125.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5330.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":5125.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8580.58,"10th_percentile":231.44,"90th_percentile":9534.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Infections Without Mcc","code_information":[{"code":"690","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6745.27,"maximum":14885.82,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7082.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14885.82},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":6745.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6745.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7015.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":6745.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5899.3,"10th_percentile":5899.3,"90th_percentile":8153.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6984.51,"10th_percentile":6984.51,"90th_percentile":6984.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc","code_information":[{"code":"743","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10083.16,"maximum":22230.43,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10587.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22230.43},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":10083.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10083.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10486.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":10083.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"D&C, Conization, Laparoscopy And Tubal Interruption With Cc/Mcc","code_information":[{"code":"744","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16340.93,"maximum":36238.98,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17157.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36238.98},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":16340.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16340.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16994.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":16340.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infections, Female Reproductive System Without Cc/Mcc","code_information":[{"code":"759","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5615.86,"maximum":11868.23,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11868.23},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":5615.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5615.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5840.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":5615.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Procedures","code_information":[{"code":"776","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5546.97,"maximum":13231.43,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5824.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13231.43},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":5546.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5546.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5768.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":5546.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Abortion Without D&C","code_information":[{"code":"779","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6991.43,"maximum":17335.88,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7341.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17335.88},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":6991.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6991.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7271.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":6991.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","code_information":[{"code":"809","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10278.23,"maximum":22970.46,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10792.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22970.46},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":10278.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10278.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10689.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":10278.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","code_information":[{"code":"810","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8580.64,"maximum":17651.18,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9009.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17651.18},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":8580.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8580.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8923.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":8580.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Red Blood Cell Disorders With Mcc","code_information":[{"code":"811","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11349.57,"maximum":26091.92,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11917.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26091.92},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":11349.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11349.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11803.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":11349.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"1 through 10","median_amount":27144.23,"10th_percentile":27144.23,"90th_percentile":27144.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":294.19,"10th_percentile":294.19,"90th_percentile":294.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Red Blood Cell Disorders Without Mcc","code_information":[{"code":"812","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7586.7,"maximum":17117.03,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7966.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17117.03},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":7586.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7586.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7890.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":7586.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 70.85] [All Other IP (%BC): 70.85]","count":"1 through 10","median_amount":11370.57,"10th_percentile":11370.57,"90th_percentile":11370.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coagulation Disorders","code_information":[{"code":"813","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12286.22,"maximum":28708.9,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12900.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28708.9},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":12286.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12286.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12777.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":12286.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infectious And Parasitic Diseases With O.R. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infectious And Parasitic Diseases With O.R. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":7979.5,"10th_percentile":7979.5,"90th_percentile":7979.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fever And Inflammatory Conditions","code_information":[{"code":"864","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7350.61,"maximum":16653.35,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7718.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16653.35},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":7350.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7350.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7644.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":7350.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 70.85] [All Other IP (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7124.17,"10th_percentile":7124.17,"90th_percentile":7124.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Viral Illness With Mcc","code_information":[{"code":"865","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12077.22,"maximum":27373.52,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12681.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27373.52},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":12077.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12077.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12560.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":12077.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":479.89,"10th_percentile":479.89,"90th_percentile":479.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Viral Illness Without Mcc","code_information":[{"code":"866","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7210.5,"maximum":16408.53,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7571.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16408.53},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":7210.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7210.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7498.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":7210.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Infectious And Parasitic Diseases Diagnoses With Mcc","code_information":[{"code":"867","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16682.3,"maximum":39768.48,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17516.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39768.48},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":16682.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16682.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17349.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":16682.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc","code_information":[{"code":"871","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15515.74,"maximum":36394.78,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16291.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36394.78},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":15515.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15515.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16136.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":15515.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":11820.71,"10th_percentile":8763.85,"90th_percentile":19421.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"1 through 10","median_amount":42163.01,"10th_percentile":30211.98,"90th_percentile":52199.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"21","median_amount":11338.96,"10th_percentile":807.83,"90th_percentile":19657.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"1 through 10","median_amount":50260.21,"10th_percentile":50260.21,"90th_percentile":50260.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"28","median_amount":13602.07,"10th_percentile":5647.64,"90th_percentile":16732.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"12","median_amount":16781.74,"10th_percentile":15338.41,"90th_percentile":16781.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc","code_information":[{"code":"872","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8400.28,"maximum":19121.96,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8820.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19121.96},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":8400.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8400.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8736.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":8400.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":716.16,"10th_percentile":716.16,"90th_percentile":716.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"1 through 10","median_amount":32234.22,"10th_percentile":32234.22,"90th_percentile":32234.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"1 through 10","median_amount":8528.79,"10th_percentile":8528.79,"90th_percentile":8528.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":3893.31,"10th_percentile":2210.91,"90th_percentile":9324.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"1 through 10","median_amount":25173.77,"10th_percentile":25173.77,"90th_percentile":25173.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5908.47,"10th_percentile":5860.0,"90th_percentile":7154.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Depressive Neuroses","code_information":[{"code":"881","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7762.42,"maximum":16953.81,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8150.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16953.81},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":7762.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7762.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8072.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":7762.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5785.88,"10th_percentile":5785.88,"90th_percentile":5785.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"1 through 10","median_amount":4696.0,"10th_percentile":4696.0,"90th_percentile":4696.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neuroses Except Depressive","code_information":[{"code":"882","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8791.19,"maximum":17840.36,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9230.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17840.36},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":8791.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8791.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9142.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":8791.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14299.07,"10th_percentile":14299.07,"90th_percentile":14299.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Psychoses","code_information":[{"code":"885","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11291.51,"maximum":26142.0,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11856.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26142.0},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":11291.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11291.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11743.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":11291.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"47","median_amount":5817.83,"10th_percentile":2695.4,"90th_percentile":13557.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11612.0,"10th_percentile":11612.0,"90th_percentile":11612.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"11","median_amount":10352.96,"10th_percentile":4277.35,"90th_percentile":13120.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"1 through 10","median_amount":2139.01,"10th_percentile":2139.01,"90th_percentile":2139.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"21","median_amount":4643.53,"10th_percentile":2697.43,"90th_percentile":9590.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":3568.65,"10th_percentile":2393.78,"90th_percentile":8162.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Behavioral And Developmental Disorders","code_information":[{"code":"886","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16543.74,"maximum":33317.83,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17370.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33317.83},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":16543.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16543.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17205.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":16543.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"20","median_amount":6944.49,"10th_percentile":4586.5,"90th_percentile":10147.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"30","median_amount":5662.65,"10th_percentile":4222.73,"90th_percentile":12267.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7520.76,"10th_percentile":7520.76,"90th_percentile":7520.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"11","median_amount":4166.07,"10th_percentile":456.51,"90th_percentile":7363.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"1 through 10","median_amount":10081.93,"10th_percentile":5275.47,"90th_percentile":11610.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6045.3,"10th_percentile":5933.64,"90th_percentile":6999.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":3738.26,"10th_percentile":3738.26,"90th_percentile":3738.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Wound Debridements For Injuries With Mcc","code_information":[{"code":"901","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32964.58,"maximum":82166.92,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34612.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":82166.92},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":32964.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32964.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34283.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":32964.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Injuries Without Cc/Mcc","code_information":[{"code":"909","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10640.5,"maximum":23521.31,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11172.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23521.31},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":10640.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10640.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11066.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":10640.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 70.85] [All Other IP (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":9164.46,"10th_percentile":9164.46,"90th_percentile":9164.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Injury With Mcc","code_information":[{"code":"913","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13132.31,"maximum":30012.76,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13788.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30012.76},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":13132.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13132.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13657.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":13132.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 70.85] [All Other IP (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11217.52,"10th_percentile":11217.52,"90th_percentile":11217.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Injury Without Mcc","code_information":[{"code":"914","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7333.58,"maximum":16994.62,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7700.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16994.62},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":7333.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7333.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7626.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":7333.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 70.85] [All Other IP (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8073.77,"10th_percentile":8073.77,"90th_percentile":8073.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Allergic Reactions With Mcc","code_information":[{"code":"915","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13496.13,"maximum":32230.98,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14170.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32230.98},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":13496.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13496.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14035.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":13496.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 70.85] [All Other IP (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Allergic Reactions Without Mcc","code_information":[{"code":"916","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5636.76,"maximum":12315.21,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5918.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12315.21},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":5636.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5636.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5862.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":5636.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"1 through 10","median_amount":7132.47,"10th_percentile":7132.47,"90th_percentile":7132.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":6420.24,"10th_percentile":6420.24,"90th_percentile":6420.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12461.58,"10th_percentile":12458.88,"90th_percentile":13987.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14039.66,"10th_percentile":14039.66,"90th_percentile":14039.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Poisoning And Toxic Effects Of Drugs Without Mcc","code_information":[{"code":"918","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7113.73,"maximum":16402.97,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7469.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16402.97},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":7113.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7113.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7398.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":7113.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":3434.71,"10th_percentile":3434.71,"90th_percentile":3434.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2654.0,"10th_percentile":2654.0,"90th_percentile":2654.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7517.76,"10th_percentile":7517.76,"90th_percentile":7517.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complications Of Treatment With Mcc","code_information":[{"code":"919","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14651.08,"maximum":33818.6,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15383.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33818.6},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":14651.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14651.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15237.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":14651.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complications Of Treatment With Cc","code_information":[{"code":"920","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8237.72,"maximum":18840.04,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8649.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18840.04},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":8237.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8237.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8567.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":8237.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/Mcc","code_information":[{"code":"941","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16175.27,"maximum":36244.55,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16984.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36244.55},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":16175.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16175.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16822.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":16175.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rehabilitation Without Cc/Mcc","code_information":[{"code":"946","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9356.28,"maximum":20705.87,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9824.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20705.87},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":9356.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9356.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9730.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":9356.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Signs And Symptoms Without Mcc","code_information":[{"code":"948","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6675.6,"maximum":14735.59,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7009.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14735.59},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":6675.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6675.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6942.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":6675.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 70.85] [All Other IP (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":7435.69,"10th_percentile":7435.69,"90th_percentile":7435.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6055.75,"10th_percentile":156.99,"90th_percentile":6683.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6917.79,"10th_percentile":6917.79,"90th_percentile":6917.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Aftercare With Cc/Mcc","code_information":[{"code":"949","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9688.37,"maximum":20010.36,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10172.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20010.36},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":9688.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9688.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10075.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":9688.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9388.17,"10th_percentile":9388.17,"90th_percentile":9388.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare Without Cc/Mcc","code_information":[{"code":"950","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5337.96,"maximum":10870.4,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5604.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10870.4},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":5337.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5337.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5551.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":5337.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5044.25,"10th_percentile":5044.25,"90th_percentile":5044.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Craniotomy For Multiple Significant Trauma","code_information":[{"code":"955","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":52583.97,"maximum":126637.06,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55213.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":126637.06},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":52583.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52583.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54687.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":52583.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Multiple Significant Trauma With Mcc","code_information":[{"code":"963","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21641.14,"maximum":50384.78,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22723.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50384.78},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":21641.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21641.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22506.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":21641.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Procedures With Mcc","code_information":[{"code":"969","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":47863.55,"maximum":117289.37,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50256.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":117289.37},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":47863.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47863.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49778.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":47863.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Extensive O.R. Procedures Without Mcc","code_information":[{"code":"970","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20894.92,"maximum":49208.9,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21939.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49208.9},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":20894.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20894.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21730.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":20894.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Major Related Condition With Mcc","code_information":[{"code":"974","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22819.31,"maximum":55381.34,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23960.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55381.34},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":22819.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22819.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23732.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":22819.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 70.85] [All Other IP (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Major Related Condition With Cc","code_information":[{"code":"975","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10503.49,"maximum":26360.85,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11028.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26360.85},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":10503.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10503.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10923.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":10503.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 70.85] [All Other IP (%BC): 70.85]","count":"1 through 10","median_amount":7003.83,"10th_percentile":7003.83,"90th_percentile":7003.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Major Related Condition Without Cc/Mcc","code_information":[{"code":"976","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7466.72,"maximum":18600.79,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7840.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18600.79},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":7466.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7466.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7765.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":7466.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 70.85] [All Other IP (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Or Without Other Related Condition","code_information":[{"code":"977","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10524.39,"maximum":26741.06,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11050.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26741.06},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":10524.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10524.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10945.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":10524.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 70.85] [All Other IP (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","code_information":[{"code":"981","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":36797.89,"maximum":88178.0,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38637.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":88178.0},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":36797.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36797.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38269.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":36797.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":19266.83,"10th_percentile":19266.83,"90th_percentile":19266.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"1 through 10","median_amount":39940.23,"10th_percentile":39940.23,"90th_percentile":39940.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","code_information":[{"code":"982","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19510.06,"maximum":45412.33,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20485.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45412.33},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":19510.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19510.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20290.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":19510.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12708.61,"10th_percentile":12708.61,"90th_percentile":12708.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive O.R. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Extensive O.R. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Major Eye Infections","code_information":[{"code":"044","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 70.85] [All Other IP (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neurological eye disorders","code_information":[{"code":"045","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 70.85] [All Other IP (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders of the Eye Age >17 w CC","code_information":[{"code":"046","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 70.85] [All Other IP (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders of the Eye Age >17 w/o CC","code_information":[{"code":"047","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 70.85] [All Other IP (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders of the Eye Age 0-17","code_information":[{"code":"048","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 70.85] [All Other IP (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head & Neck Procedures","code_information":[{"code":"049","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 70.85] [All Other IP (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sialoadenectomy","code_information":[{"code":"050","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 70.85] [All Other IP (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Salivary Gland Procedures Except Sialoadenectomy","code_information":[{"code":"051","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 70.85] [All Other IP (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve & Oth Major Cardiothoracic Proc w Cardiac Cath","code_information":[{"code":"104","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 70.85] [All Other IP (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve & Oth Major Cardiothoracic Proc w/o Cardiac Cath","code_information":[{"code":"105","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 70.85] [All Other IP (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass w PTCA","code_information":[{"code":"106","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 70.85] [All Other IP (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"107","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cardiothoracic Procedures","code_information":[{"code":"108","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Cardiovascular Procedures w CC","code_information":[{"code":"110","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Cardiovascular Procedures w/o CC","code_information":[{"code":"111","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 70.85] [All Other IP (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"112","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 70.85] [All Other IP (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Device Replacement","code_information":[{"code":"118","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other circulatory system O.R. procedures","code_information":[{"code":"120","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute & Subacute Endocarditis","code_information":[{"code":"126","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 70.85] [All Other IP (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Failure & Shock","code_information":[{"code":"127","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cranial/Facial Procedures W/O Cc/Mcc","code_information":[{"code":"132","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/Mcc","code_information":[{"code":"133","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 70.85] [All Other IP (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/Mcc","code_information":[{"code":"134","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 70.85] [All Other IP (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hernia Procedures Except Inguinal & Femoral Age >17 w/o CC","code_information":[{"code":"160","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 70.85] [All Other IP (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal & Femoral Hernia Procedures Age >17 w CC","code_information":[{"code":"161","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 70.85] [All Other IP (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal & Femoral Hernia Procedures Age >17 w/o CC","code_information":[{"code":"162","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 70.85] [All Other IP (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mouth Procedures w/o CC","code_information":[{"code":"169","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Procedures w/o CC","code_information":[{"code":"171","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complex Aortic Arch Procedures","code_information":[{"code":"209","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":88097.05,"maximum":92501.9,"payers_information":[{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":92501.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"fee schedule","standard_charge_dollar":88097.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":88097.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":91620.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"fee schedule","standard_charge_dollar":88097.05,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Hip & Femur Procedures Except Major Joint Age >17 w CC","code_information":[{"code":"210","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 70.85] [All Other IP (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip & Femur Procedures Except Major Joint Age >17 w/o CC","code_information":[{"code":"211","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other cardiothoracic procedures w/o CC/MCC","code_information":[{"code":"230","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major cardiovasc procedures w MCC","code_information":[{"code":"237","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endoscopic Tubal Interruption","code_information":[{"code":"362","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Procedures","code_information":[{"code":"365","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, female reproductive system w CC","code_information":[{"code":"366","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Female Reproductive System w/o CC","code_information":[{"code":"367","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Red Blood Cell Disorders Age 0-17","code_information":[{"code":"396","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma & non-acute leukemia w other O.R. proc w CC","code_information":[{"code":"401","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma & non-acute leukemia w CC","code_information":[{"code":"403","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 70.85] [All Other IP (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma & Non-Acute Leukemia w/o CC","code_information":[{"code":"404","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 70.85] [All Other IP (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Childhood Mental Disorders","code_information":[{"code":"431","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complications of treatment w CC","code_information":[{"code":"452","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major joint & limb reattachment proc of upper extremity w/o CC/MCC","code_information":[{"code":"484","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back & neck proc exc spinal fusion w CC/MCC or disc device/neurostim","code_information":[{"code":"490","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"526","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures w CC","code_information":[{"code":"531","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 70.85] [All Other IP (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures w/o CC","code_information":[{"code":"532","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 70.85] [All Other IP (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal & Duodenal Proc Age > 17 w CC w Major Gi Dx","code_information":[{"code":"567","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 70.85] [All Other IP (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Small & Large Bowel Procedures w CC w Major Gi Dx","code_information":[{"code":"569","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Admit For Renal Dialysis","code_information":[{"code":"685","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 70.85] [All Other IP (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery W Complicating Diagnoses","code_information":[{"code":"774","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses W/O Medical Complications","code_information":[{"code":"782","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Principal Diagnosis Invalid As Discharge Diagnosis","code_information":[{"code":"998","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ungroupable","code_information":[{"code":"999","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 70.85] [All Other IP (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 55000 | Excess % of Charge: 70.85] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76.5] [All Other IP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 85] [All Other IP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inj, bupivacaine liposome","code_information":[{"code":"0763","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Coventry/Non Gatekeeper Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72.8] [OP Surgery  (%BC): 72.8] [Observation (%BC): 72.8] [Emergency Department (%BC): 72.8] [Occupational Therapy (%BC): 72.8] [Physical Therapy (%BC): 72.8] [Respiratory Services/Therapy  (%BC): 72.8] [Speech Therapy (%BC): 72.8] [All Other OP (%BC): 72.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70.85] [OP Surgery  (%BC): 70.85] [Observation (%BC): 70.85] [Emergency Department (%BC): 70.85] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85]","count":"1 through 10","median_amount":29707.73,"10th_percentile":29707.73,"90th_percentile":29707.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 71.54 Maximum Reimbursement 48190] [Cardiac Cath (%BC): 71.54 Maximum Reimbursement 54213] [Observation (%BC): 71.54 Maximum Reimbursement 15662] [Emergency Department (%BC): 71.54 Maximum Reimbursement 15662] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85 Charge Threshold 60000 (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ketorolac tromethamine inj","code_information":[{"code":"0764","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1001.74,"10th_percentile":1001.74,"90th_percentile":1001.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Coventry/Non Gatekeeper Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72.8] [OP Surgery  (%BC): 72.8] [Observation (%BC): 72.8] [Emergency Department (%BC): 72.8] [Occupational Therapy (%BC): 72.8] [Physical Therapy (%BC): 72.8] [Respiratory Services/Therapy  (%BC): 72.8] [Speech Therapy (%BC): 72.8] [All Other OP (%BC): 72.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70.85] [OP Surgery  (%BC): 70.85] [Observation (%BC): 70.85] [Emergency Department (%BC): 70.85] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85]","count":"1 through 10","median_amount":24707.42,"10th_percentile":24707.42,"90th_percentile":24707.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 71.54 Maximum Reimbursement 48190] [Cardiac Cath (%BC): 71.54 Maximum Reimbursement 54213] [Observation (%BC): 71.54 Maximum Reimbursement 15662] [Emergency Department (%BC): 71.54 Maximum Reimbursement 15662] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85 Charge Threshold 60000 (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2383.56,"10th_percentile":2383.56,"90th_percentile":2383.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7447.77,"10th_percentile":7447.77,"90th_percentile":7447.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Inj, glycopyrrolate, 0.1 mg","code_information":[{"code":"0792","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Coventry/Non Gatekeeper Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72.8] [OP Surgery  (%BC): 72.8] [Observation (%BC): 72.8] [Emergency Department (%BC): 72.8] [Occupational Therapy (%BC): 72.8] [Physical Therapy (%BC): 72.8] [Respiratory Services/Therapy  (%BC): 72.8] [Speech Therapy (%BC): 72.8] [All Other OP (%BC): 72.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70.85] [OP Surgery  (%BC): 70.85] [Observation (%BC): 70.85] [Emergency Department (%BC): 70.85] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85]","count":"1 through 10","median_amount":10813.47,"10th_percentile":10813.47,"90th_percentile":10813.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":593.46,"10th_percentile":593.46,"90th_percentile":593.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 71.54 Maximum Reimbursement 48190] [Cardiac Cath (%BC): 71.54 Maximum Reimbursement 54213] [Observation (%BC): 71.54 Maximum Reimbursement 15662] [Emergency Department (%BC): 71.54 Maximum Reimbursement 15662] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85 Charge Threshold 60000 (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Clinic Visits and Related Services","code_information":[{"code":"5012","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":189.23,"10th_percentile":189.23,"90th_percentile":189.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Coventry/Non Gatekeeper Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72.8] [OP Surgery  (%BC): 72.8] [Observation (%BC): 72.8] [Emergency Department (%BC): 72.8] [Occupational Therapy (%BC): 72.8] [Physical Therapy (%BC): 72.8] [Respiratory Services/Therapy  (%BC): 72.8] [Speech Therapy (%BC): 72.8] [All Other OP (%BC): 72.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70.85] [OP Surgery  (%BC): 70.85] [Observation (%BC): 70.85] [Emergency Department (%BC): 70.85] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85]","count":"14","median_amount":88.5,"10th_percentile":81.91,"90th_percentile":184.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 71.54 Maximum Reimbursement 48190] [Cardiac Cath (%BC): 71.54 Maximum Reimbursement 54213] [Observation (%BC): 71.54 Maximum Reimbursement 15662] [Emergency Department (%BC): 71.54 Maximum Reimbursement 15662] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85 Charge Threshold 60000 (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":83.43,"10th_percentile":83.43,"90th_percentile":84.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":76.73,"10th_percentile":76.73,"90th_percentile":92.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":159.2,"10th_percentile":159.2,"90th_percentile":159.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [APC ($): FEE SCHEDULE]","count":"11","median_amount":116.11,"10th_percentile":114.22,"90th_percentile":118.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":117.39,"10th_percentile":117.39,"90th_percentile":117.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"1 through 10","median_amount":80.24,"10th_percentile":75.23,"90th_percentile":100.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"14","median_amount":118.0,"10th_percentile":118.0,"90th_percentile":126.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"195","median_amount":134.34,"10th_percentile":124.15,"90th_percentile":134.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Type A ED Visits","code_information":[{"code":"5021","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":166.36,"10th_percentile":131.57,"90th_percentile":263.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Coventry/Non Gatekeeper Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72.8] [OP Surgery  (%BC): 72.8] [Observation (%BC): 72.8] [Emergency Department (%BC): 72.8] [Occupational Therapy (%BC): 72.8] [Physical Therapy (%BC): 72.8] [Respiratory Services/Therapy  (%BC): 72.8] [Speech Therapy (%BC): 72.8] [All Other OP (%BC): 72.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70.85] [OP Surgery  (%BC): 70.85] [Observation (%BC): 70.85] [Emergency Department (%BC): 70.85] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85]","count":"1 through 10","median_amount":267.81,"10th_percentile":267.81,"90th_percentile":267.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":353.99,"10th_percentile":353.99,"90th_percentile":353.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 71.54 Maximum Reimbursement 48190] [Cardiac Cath (%BC): 71.54 Maximum Reimbursement 54213] [Observation (%BC): 71.54 Maximum Reimbursement 15662] [Emergency Department (%BC): 71.54 Maximum Reimbursement 15662] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85 Charge Threshold 60000 (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":224.42,"10th_percentile":224.42,"90th_percentile":257.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":141.84,"10th_percentile":141.84,"90th_percentile":141.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":201.47,"10th_percentile":201.47,"90th_percentile":201.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"1 through 10","median_amount":75.06,"10th_percentile":75.06,"90th_percentile":75.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Type A ED Visits","code_information":[{"code":"5022","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Coventry/Non Gatekeeper Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72.8] [OP Surgery  (%BC): 72.8] [Observation (%BC): 72.8] [Emergency Department (%BC): 72.8] [Occupational Therapy (%BC): 72.8] [Physical Therapy (%BC): 72.8] [Respiratory Services/Therapy  (%BC): 72.8] [Speech Therapy (%BC): 72.8] [All Other OP (%BC): 72.8]","count":"1 through 10","median_amount":541.28,"10th_percentile":541.28,"90th_percentile":1040.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70.85] [OP Surgery  (%BC): 70.85] [Observation (%BC): 70.85] [Emergency Department (%BC): 70.85] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85]","count":"87","median_amount":645.97,"10th_percentile":387.95,"90th_percentile":1399.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"91","median_amount":204.54,"10th_percentile":153.73,"90th_percentile":376.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"1 through 10","median_amount":1004.41,"10th_percentile":1004.41,"90th_percentile":1056.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 71.54 Maximum Reimbursement 48190] [Cardiac Cath (%BC): 71.54 Maximum Reimbursement 54213] [Observation (%BC): 71.54 Maximum Reimbursement 15662] [Emergency Department (%BC): 71.54 Maximum Reimbursement 15662] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85 Charge Threshold 60000 (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"23","median_amount":777.02,"10th_percentile":441.9,"90th_percentile":1790.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":776.55,"10th_percentile":776.55,"90th_percentile":2167.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"208","median_amount":225.08,"10th_percentile":148.19,"90th_percentile":370.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"39","median_amount":227.25,"10th_percentile":165.71,"90th_percentile":433.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":156.07,"10th_percentile":151.14,"90th_percentile":162.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"95","median_amount":219.68,"10th_percentile":157.31,"90th_percentile":349.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"11","median_amount":867.68,"10th_percentile":264.75,"90th_percentile":1743.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"26","median_amount":161.51,"10th_percentile":31.05,"90th_percentile":406.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":165.08,"10th_percentile":153.6,"90th_percentile":399.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Type A ED Visits","code_information":[{"code":"5023","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"532","median_amount":239.55,"10th_percentile":166.36,"90th_percentile":620.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Coventry/Non Gatekeeper Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72.8] [OP Surgery  (%BC): 72.8] [Observation (%BC): 72.8] [Emergency Department (%BC): 72.8] [Occupational Therapy (%BC): 72.8] [Physical Therapy (%BC): 72.8] [Respiratory Services/Therapy  (%BC): 72.8] [Speech Therapy (%BC): 72.8] [All Other OP (%BC): 72.8]","count":"1 through 10","median_amount":1575.16,"10th_percentile":1063.13,"90th_percentile":1697.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70.85] [OP Surgery  (%BC): 70.85] [Observation (%BC): 70.85] [Emergency Department (%BC): 70.85] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85]","count":"439","median_amount":1534.28,"10th_percentile":774.82,"90th_percentile":3965.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"352","median_amount":233.89,"10th_percentile":166.36,"90th_percentile":581.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"19","median_amount":1626.44,"10th_percentile":880.64,"90th_percentile":6779.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 71.54 Maximum Reimbursement 48190] [Cardiac Cath (%BC): 71.54 Maximum Reimbursement 54213] [Observation (%BC): 71.54 Maximum Reimbursement 15662] [Emergency Department (%BC): 71.54 Maximum Reimbursement 15662] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85 Charge Threshold 60000 (%BC): 70.85]","count":"11","median_amount":2934.45,"10th_percentile":1268.03,"90th_percentile":8715.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"102","median_amount":1649.85,"10th_percentile":856.48,"90th_percentile":3497.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"17","median_amount":1356.05,"10th_percentile":780.64,"90th_percentile":4299.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"890","median_amount":238.43,"10th_percentile":169.59,"90th_percentile":632.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"145","median_amount":240.32,"10th_percentile":172.24,"90th_percentile":523.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [APC ($): FEE SCHEDULE]","count":"24","median_amount":263.68,"10th_percentile":221.67,"90th_percentile":481.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"343","median_amount":222.0,"10th_percentile":166.36,"90th_percentile":471.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":464.39,"10th_percentile":464.39,"90th_percentile":625.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":288.64,"10th_percentile":288.64,"90th_percentile":288.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"72","median_amount":2080.32,"10th_percentile":839.98,"90th_percentile":7390.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"231","median_amount":282.99,"10th_percentile":186.39,"90th_percentile":534.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"30","median_amount":410.6,"10th_percentile":288.64,"90th_percentile":806.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 4 Type A ED Visits","code_information":[{"code":"5024","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"372","median_amount":657.61,"10th_percentile":220.79,"90th_percentile":1199.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Coventry/Non Gatekeeper Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72.8] [OP Surgery  (%BC): 72.8] [Observation (%BC): 72.8] [Emergency Department (%BC): 72.8] [Occupational Therapy (%BC): 72.8] [Physical Therapy (%BC): 72.8] [Respiratory Services/Therapy  (%BC): 72.8] [Speech Therapy (%BC): 72.8] [All Other OP (%BC): 72.8]","count":"1 through 10","median_amount":6107.67,"10th_percentile":6107.67,"90th_percentile":9149.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70.85] [OP Surgery  (%BC): 70.85] [Observation (%BC): 70.85] [Emergency Department (%BC): 70.85] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85]","count":"555","median_amount":4561.19,"10th_percentile":2212.93,"90th_percentile":9400.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"292","median_amount":660.65,"10th_percentile":220.79,"90th_percentile":1268.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"26","median_amount":3448.59,"10th_percentile":1931.48,"90th_percentile":10020.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 71.54 Maximum Reimbursement 48190] [Cardiac Cath (%BC): 71.54 Maximum Reimbursement 54213] [Observation (%BC): 71.54 Maximum Reimbursement 15662] [Emergency Department (%BC): 71.54 Maximum Reimbursement 15662] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85 Charge Threshold 60000 (%BC): 70.85]","count":"12","median_amount":4257.01,"10th_percentile":2708.09,"90th_percentile":8133.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"137","median_amount":5436.58,"10th_percentile":2397.68,"90th_percentile":9710.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"40","median_amount":3848.44,"10th_percentile":1954.68,"90th_percentile":8361.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"609","median_amount":656.78,"10th_percentile":226.31,"90th_percentile":1254.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"104","median_amount":382.73,"10th_percentile":240.32,"90th_percentile":853.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [APC ($): FEE SCHEDULE]","count":"15","median_amount":670.38,"10th_percentile":348.0,"90th_percentile":1028.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"261","median_amount":643.15,"10th_percentile":222.92,"90th_percentile":1242.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":587.79,"10th_percentile":587.79,"90th_percentile":587.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"100","median_amount":4968.98,"10th_percentile":1472.8,"90th_percentile":10631.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"256","median_amount":672.84,"10th_percentile":329.91,"90th_percentile":1079.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"62","median_amount":766.18,"10th_percentile":501.31,"90th_percentile":1109.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 5 Type A ED Visits","code_information":[{"code":"5025","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"295","median_amount":932.98,"10th_percentile":320.6,"90th_percentile":1445.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Coventry/Non Gatekeeper Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72.8] [OP Surgery  (%BC): 72.8] [Observation (%BC): 72.8] [Emergency Department (%BC): 72.8] [Occupational Therapy (%BC): 72.8] [Physical Therapy (%BC): 72.8] [Respiratory Services/Therapy  (%BC): 72.8] [Speech Therapy (%BC): 72.8] [All Other OP (%BC): 72.8]","count":"1 through 10","median_amount":4073.78,"10th_percentile":3765.46,"90th_percentile":6730.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70.85] [OP Surgery  (%BC): 70.85] [Observation (%BC): 70.85] [Emergency Department (%BC): 70.85] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85]","count":"458","median_amount":8144.47,"10th_percentile":3456.75,"90th_percentile":14981.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"242","median_amount":883.94,"10th_percentile":330.15,"90th_percentile":1341.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"31","median_amount":6598.45,"10th_percentile":3189.29,"90th_percentile":12142.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 71.54 Maximum Reimbursement 48190] [Cardiac Cath (%BC): 71.54 Maximum Reimbursement 54213] [Observation (%BC): 71.54 Maximum Reimbursement 15662] [Emergency Department (%BC): 71.54 Maximum Reimbursement 15662] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85 Charge Threshold 60000 (%BC): 70.85]","count":"19","median_amount":6697.04,"10th_percentile":1994.13,"90th_percentile":14614.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"111","median_amount":8254.04,"10th_percentile":4033.05,"90th_percentile":14649.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"35","median_amount":7999.76,"10th_percentile":3845.65,"90th_percentile":16523.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"515","median_amount":925.03,"10th_percentile":340.41,"90th_percentile":1512.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"144","median_amount":358.87,"10th_percentile":282.77,"90th_percentile":1106.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [APC ($): FEE SCHEDULE]","count":"12","median_amount":1060.75,"10th_percentile":745.21,"90th_percentile":2163.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"264","median_amount":936.22,"10th_percentile":333.68,"90th_percentile":1387.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1065.78,"10th_percentile":1065.78,"90th_percentile":1065.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"69","median_amount":9616.15,"10th_percentile":3770.65,"90th_percentile":16461.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"285","median_amount":1115.86,"10th_percentile":764.36,"90th_percentile":2153.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"92","median_amount":1184.48,"10th_percentile":841.75,"90th_percentile":2667.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Critical Care","code_information":[{"code":"5041","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2689.24,"10th_percentile":2689.24,"90th_percentile":2689.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Coventry/Non Gatekeeper Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72.8] [OP Surgery  (%BC): 72.8] [Observation (%BC): 72.8] [Emergency Department (%BC): 72.8] [Occupational Therapy (%BC): 72.8] [Physical Therapy (%BC): 72.8] [Respiratory Services/Therapy  (%BC): 72.8] [Speech Therapy (%BC): 72.8] [All Other OP (%BC): 72.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70.85] [OP Surgery  (%BC): 70.85] [Observation (%BC): 70.85] [Emergency Department (%BC): 70.85] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85]","count":"1 through 10","median_amount":9574.15,"10th_percentile":5469.1,"90th_percentile":23821.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1633.11,"10th_percentile":1055.7,"90th_percentile":6516.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 71.54 Maximum Reimbursement 48190] [Cardiac Cath (%BC): 71.54 Maximum Reimbursement 54213] [Observation (%BC): 71.54 Maximum Reimbursement 15662] [Emergency Department (%BC): 71.54 Maximum Reimbursement 15662] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85 Charge Threshold 60000 (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":4861.56,"10th_percentile":4861.56,"90th_percentile":4861.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1378.22,"10th_percentile":926.73,"90th_percentile":2184.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":736.23,"10th_percentile":736.23,"90th_percentile":736.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1681.49,"10th_percentile":1681.49,"90th_percentile":1681.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2311.44,"10th_percentile":1683.09,"90th_percentile":10724.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2288.63,"10th_percentile":2288.63,"90th_percentile":2303.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Skin Procedures","code_information":[{"code":"5051","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":481.9,"10th_percentile":457.08,"90th_percentile":933.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Coventry/Non Gatekeeper Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72.8] [OP Surgery  (%BC): 72.8] [Observation (%BC): 72.8] [Emergency Department (%BC): 72.8] [Occupational Therapy (%BC): 72.8] [Physical Therapy (%BC): 72.8] [Respiratory Services/Therapy  (%BC): 72.8] [Speech Therapy (%BC): 72.8] [All Other OP (%BC): 72.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70.85] [OP Surgery  (%BC): 70.85] [Observation (%BC): 70.85] [Emergency Department (%BC): 70.85] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85]","count":"25","median_amount":1478.25,"10th_percentile":590.25,"90th_percentile":2730.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":464.09,"10th_percentile":201.93,"90th_percentile":493.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"1 through 10","median_amount":495.26,"10th_percentile":495.26,"90th_percentile":495.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 71.54 Maximum Reimbursement 48190] [Cardiac Cath (%BC): 71.54 Maximum Reimbursement 54213] [Observation (%BC): 71.54 Maximum Reimbursement 15662] [Emergency Department (%BC): 71.54 Maximum Reimbursement 15662] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85 Charge Threshold 60000 (%BC): 70.85]","count":"1 through 10","median_amount":909.09,"10th_percentile":909.09,"90th_percentile":909.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":1807.54,"10th_percentile":707.0,"90th_percentile":8556.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"27","median_amount":465.96,"10th_percentile":205.85,"90th_percentile":1006.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":492.76,"10th_percentile":492.76,"90th_percentile":492.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":460.25,"10th_percentile":205.02,"90th_percentile":493.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"1 through 10","median_amount":1733.77,"10th_percentile":1733.77,"90th_percentile":2623.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"13","median_amount":256.59,"10th_percentile":170.52,"90th_percentile":403.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":207.13,"10th_percentile":134.34,"90th_percentile":288.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Skin Procedures","code_information":[{"code":"5052","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"21","median_amount":713.92,"10th_percentile":522.14,"90th_percentile":1441.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Coventry/Non Gatekeeper Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72.8] [OP Surgery  (%BC): 72.8] [Observation (%BC): 72.8] [Emergency Department (%BC): 72.8] [Occupational Therapy (%BC): 72.8] [Physical Therapy (%BC): 72.8] [Respiratory Services/Therapy  (%BC): 72.8] [Speech Therapy (%BC): 72.8] [All Other OP (%BC): 72.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70.85] [OP Surgery  (%BC): 70.85] [Observation (%BC): 70.85] [Emergency Department (%BC): 70.85] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85]","count":"48","median_amount":3305.44,"10th_percentile":1680.41,"90th_percentile":6861.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"28","median_amount":1201.11,"10th_percentile":645.99,"90th_percentile":3415.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"1 through 10","median_amount":3137.49,"10th_percentile":3137.49,"90th_percentile":3137.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 71.54 Maximum Reimbursement 48190] [Cardiac Cath (%BC): 71.54 Maximum Reimbursement 54213] [Observation (%BC): 71.54 Maximum Reimbursement 15662] [Emergency Department (%BC): 71.54 Maximum Reimbursement 15662] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85 Charge Threshold 60000 (%BC): 70.85]","count":"1 through 10","median_amount":3348.44,"10th_percentile":2249.11,"90th_percentile":10823.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":2358.62,"10th_percentile":1508.5,"90th_percentile":9676.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":1408.32,"10th_percentile":1408.32,"90th_percentile":1408.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"46","median_amount":727.79,"10th_percentile":503.37,"90th_percentile":2013.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":554.41,"10th_percentile":554.41,"90th_percentile":554.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"11","median_amount":948.75,"10th_percentile":247.63,"90th_percentile":1223.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"15","median_amount":3436.38,"10th_percentile":1500.25,"90th_percentile":10170.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"65","median_amount":852.3,"10th_percentile":381.69,"90th_percentile":1415.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":757.2,"10th_percentile":416.48,"90th_percentile":1040.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Skin Procedures","code_information":[{"code":"5053","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":466.93,"10th_percentile":466.93,"90th_percentile":466.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Coventry/Non Gatekeeper Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72.8] [OP Surgery  (%BC): 72.8] [Observation (%BC): 72.8] [Emergency Department (%BC): 72.8] [Occupational Therapy (%BC): 72.8] [Physical Therapy (%BC): 72.8] [Respiratory Services/Therapy  (%BC): 72.8] [Speech Therapy (%BC): 72.8] [All Other OP (%BC): 72.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70.85] [OP Surgery  (%BC): 70.85] [Observation (%BC): 70.85] [Emergency Department (%BC): 70.85] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85]","count":"1 through 10","median_amount":24472.34,"10th_percentile":24472.34,"90th_percentile":24472.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 71.54 Maximum Reimbursement 48190] [Cardiac Cath (%BC): 71.54 Maximum Reimbursement 54213] [Observation (%BC): 71.54 Maximum Reimbursement 15662] [Emergency Department (%BC): 71.54 Maximum Reimbursement 15662] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85 Charge Threshold 60000 (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1339.11,"10th_percentile":1339.11,"90th_percentile":1339.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"1 through 10","median_amount":13336.57,"10th_percentile":13336.57,"90th_percentile":13336.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":601.18,"10th_percentile":525.28,"90th_percentile":866.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Skin Procedures","code_information":[{"code":"5054","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2511.46,"10th_percentile":2511.46,"90th_percentile":3112.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Coventry/Non Gatekeeper Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72.8] [OP Surgery  (%BC): 72.8] [Observation (%BC): 72.8] [Emergency Department (%BC): 72.8] [Occupational Therapy (%BC): 72.8] [Physical Therapy (%BC): 72.8] [Respiratory Services/Therapy  (%BC): 72.8] [Speech Therapy (%BC): 72.8] [All Other OP (%BC): 72.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70.85] [OP Surgery  (%BC): 70.85] [Observation (%BC): 70.85] [Emergency Department (%BC): 70.85] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85]","count":"1 through 10","median_amount":12254.97,"10th_percentile":8001.85,"90th_percentile":16799.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2511.46,"10th_percentile":2511.46,"90th_percentile":2511.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 71.54 Maximum Reimbursement 48190] [Cardiac Cath (%BC): 71.54 Maximum Reimbursement 54213] [Observation (%BC): 71.54 Maximum Reimbursement 15662] [Emergency Department (%BC): 71.54 Maximum Reimbursement 15662] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85 Charge Threshold 60000 (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":15127.05,"10th_percentile":15127.05,"90th_percentile":15127.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2560.23,"10th_percentile":2560.23,"90th_percentile":3063.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2560.23,"10th_percentile":2560.23,"90th_percentile":2560.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1910.4,"10th_percentile":1751.51,"90th_percentile":2354.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 5 Skin Procedures","code_information":[{"code":"5055","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Coventry/Non Gatekeeper Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72.8] [OP Surgery  (%BC): 72.8] [Observation (%BC): 72.8] [Emergency Department (%BC): 72.8] [Occupational Therapy (%BC): 72.8] [Physical Therapy (%BC): 72.8] [Respiratory Services/Therapy  (%BC): 72.8] [Speech Therapy (%BC): 72.8] [All Other OP (%BC): 72.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70.85] [OP Surgery  (%BC): 70.85] [Observation (%BC): 70.85] [Emergency Department (%BC): 70.85] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85]","count":"1 through 10","median_amount":14671.72,"10th_percentile":14671.72,"90th_percentile":14671.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 71.54 Maximum Reimbursement 48190] [Cardiac Cath (%BC): 71.54 Maximum Reimbursement 54213] [Observation (%BC): 71.54 Maximum Reimbursement 15662] [Emergency Department (%BC): 71.54 Maximum Reimbursement 15662] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85 Charge Threshold 60000 (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2560.23,"10th_percentile":2560.23,"90th_percentile":2560.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3404.2,"10th_percentile":3404.2,"90th_percentile":3518.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3816.27,"10th_percentile":3816.27,"90th_percentile":3816.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Hyperbaric Oxygen","code_information":[{"code":"5061","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Coventry/Non Gatekeeper Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72.8] [OP Surgery  (%BC): 72.8] [Observation (%BC): 72.8] [Emergency Department (%BC): 72.8] [Occupational Therapy (%BC): 72.8] [Physical Therapy (%BC): 72.8] [Respiratory Services/Therapy  (%BC): 72.8] [Speech Therapy (%BC): 72.8] [All Other OP (%BC): 72.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70.85] [OP Surgery  (%BC): 70.85] [Observation (%BC): 70.85] [Emergency Department (%BC): 70.85] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85]","count":"19","median_amount":28402.37,"10th_percentile":15048.54,"90th_percentile":57034.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5108.29,"10th_percentile":5108.29,"90th_percentile":5108.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 71.54 Maximum Reimbursement 48190] [Cardiac Cath (%BC): 71.54 Maximum Reimbursement 54213] [Observation (%BC): 71.54 Maximum Reimbursement 15662] [Emergency Department (%BC): 71.54 Maximum Reimbursement 15662] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85 Charge Threshold 60000 (%BC): 70.85]","count":"1 through 10","median_amount":18746.47,"10th_percentile":18746.47,"90th_percentile":18746.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"1 through 10","median_amount":39595.72,"10th_percentile":34215.9,"90th_percentile":45500.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":9501.48,"10th_percentile":7941.9,"90th_percentile":12821.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6198.2,"10th_percentile":6198.2,"90th_percentile":6198.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Excision/ Biopsy/ Incision and Drainage","code_information":[{"code":"5071","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":514.27,"10th_percentile":514.27,"90th_percentile":514.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Coventry/Non Gatekeeper Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72.8] [OP Surgery  (%BC): 72.8] [Observation (%BC): 72.8] [Emergency Department (%BC): 72.8] [Occupational Therapy (%BC): 72.8] [Physical Therapy (%BC): 72.8] [Respiratory Services/Therapy  (%BC): 72.8] [Speech Therapy (%BC): 72.8] [All Other OP (%BC): 72.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70.85] [OP Surgery  (%BC): 70.85] [Observation (%BC): 70.85] [Emergency Department (%BC): 70.85] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85]","count":"1 through 10","median_amount":3108.93,"10th_percentile":2433.43,"90th_percentile":15272.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":883.26,"10th_percentile":883.26,"90th_percentile":883.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 71.54 Maximum Reimbursement 48190] [Cardiac Cath (%BC): 71.54 Maximum Reimbursement 54213] [Observation (%BC): 71.54 Maximum Reimbursement 15662] [Emergency Department (%BC): 71.54 Maximum Reimbursement 15662] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85 Charge Threshold 60000 (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":2654.75,"10th_percentile":2654.75,"90th_percentile":2654.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":522.14,"10th_percentile":522.14,"90th_percentile":543.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Excision/ Biopsy/ Incision and Drainage","code_information":[{"code":"5072","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1813.38,"10th_percentile":1564.3,"90th_percentile":2511.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Coventry/Non Gatekeeper Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72.8] [OP Surgery  (%BC): 72.8] [Observation (%BC): 72.8] [Emergency Department (%BC): 72.8] [Occupational Therapy (%BC): 72.8] [Physical Therapy (%BC): 72.8] [Respiratory Services/Therapy  (%BC): 72.8] [Speech Therapy (%BC): 72.8] [All Other OP (%BC): 72.8]","count":"1 through 10","median_amount":7705.61,"10th_percentile":7705.61,"90th_percentile":7705.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70.85] [OP Surgery  (%BC): 70.85] [Observation (%BC): 70.85] [Emergency Department (%BC): 70.85] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85]","count":"27","median_amount":7732.55,"10th_percentile":4187.41,"90th_percentile":13236.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1782.49,"10th_percentile":1730.47,"90th_percentile":2186.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"1 through 10","median_amount":4306.13,"10th_percentile":4306.13,"90th_percentile":4306.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 71.54 Maximum Reimbursement 48190] [Cardiac Cath (%BC): 71.54 Maximum Reimbursement 54213] [Observation (%BC): 71.54 Maximum Reimbursement 15662] [Emergency Department (%BC): 71.54 Maximum Reimbursement 15662] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85 Charge Threshold 60000 (%BC): 70.85]","count":"1 through 10","median_amount":5421.5,"10th_percentile":5421.5,"90th_percentile":5421.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":4835.95,"10th_percentile":3436.27,"90th_percentile":9888.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":4718.08,"10th_percentile":4718.08,"90th_percentile":10862.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"34","median_amount":1507.94,"10th_percentile":1285.65,"90th_percentile":1848.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1720.72,"10th_percentile":1720.72,"90th_percentile":2219.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":1678.45,"10th_percentile":1678.45,"90th_percentile":1678.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"1 through 10","median_amount":10437.16,"10th_percentile":10437.16,"90th_percentile":10437.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"13","median_amount":1496.43,"10th_percentile":1390.37,"90th_percentile":1760.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1688.97,"10th_percentile":1688.97,"90th_percentile":1688.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Excision/ Biopsy/ Incision and Drainage","code_information":[{"code":"5073","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2613.94,"10th_percentile":2314.64,"90th_percentile":2994.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Coventry/Non Gatekeeper Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72.8] [OP Surgery  (%BC): 72.8] [Observation (%BC): 72.8] [Emergency Department (%BC): 72.8] [Occupational Therapy (%BC): 72.8] [Physical Therapy (%BC): 72.8] [Respiratory Services/Therapy  (%BC): 72.8] [Speech Therapy (%BC): 72.8] [All Other OP (%BC): 72.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70.85] [OP Surgery  (%BC): 70.85] [Observation (%BC): 70.85] [Emergency Department (%BC): 70.85] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85]","count":"14","median_amount":13646.87,"10th_percentile":8430.73,"90th_percentile":16616.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2314.64,"10th_percentile":2314.64,"90th_percentile":2764.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 71.54 Maximum Reimbursement 48190] [Cardiac Cath (%BC): 71.54 Maximum Reimbursement 54213] [Observation (%BC): 71.54 Maximum Reimbursement 15662] [Emergency Department (%BC): 71.54 Maximum Reimbursement 15662] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85 Charge Threshold 60000 (%BC): 70.85]","count":"1 through 10","median_amount":11589.1,"10th_percentile":11589.1,"90th_percentile":11589.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":13555.29,"10th_percentile":13555.29,"90th_percentile":13734.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"24","median_amount":2359.58,"10th_percentile":2359.58,"90th_percentile":2931.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"13","median_amount":2459.27,"10th_percentile":2314.64,"90th_percentile":2994.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"1 through 10","median_amount":17181.6,"10th_percentile":17181.6,"90th_percentile":17181.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2722.25,"10th_percentile":2471.71,"90th_percentile":3009.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Breast/Lymphatic Surgery and Related Procedures","code_information":[{"code":"5091","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Coventry/Non Gatekeeper Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72.8] [OP Surgery  (%BC): 72.8] [Observation (%BC): 72.8] [Emergency Department (%BC): 72.8] [Occupational Therapy (%BC): 72.8] [Physical Therapy (%BC): 72.8] [Respiratory Services/Therapy  (%BC): 72.8] [Speech Therapy (%BC): 72.8] [All Other OP (%BC): 72.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70.85] [OP Surgery  (%BC): 70.85] [Observation (%BC): 70.85] [Emergency Department (%BC): 70.85] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85]","count":"1 through 10","median_amount":34474.64,"10th_percentile":23823.01,"90th_percentile":44565.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 71.54 Maximum Reimbursement 48190] [Cardiac Cath (%BC): 71.54 Maximum Reimbursement 54213] [Observation (%BC): 71.54 Maximum Reimbursement 15662] [Emergency Department (%BC): 71.54 Maximum Reimbursement 15662] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85 Charge Threshold 60000 (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3129.51,"10th_percentile":3129.51,"90th_percentile":3129.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":6262.91,"10th_percentile":6262.91,"90th_percentile":6262.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6793.42,"10th_percentile":6793.42,"90th_percentile":6928.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Breast/Lymphatic Surgery and Related Procedures","code_information":[{"code":"5092","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":8538.77,"10th_percentile":8538.77,"90th_percentile":8538.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Coventry/Non Gatekeeper Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72.8] [OP Surgery  (%BC): 72.8] [Observation (%BC): 72.8] [Emergency Department (%BC): 72.8] [Occupational Therapy (%BC): 72.8] [Physical Therapy (%BC): 72.8] [Respiratory Services/Therapy  (%BC): 72.8] [Speech Therapy (%BC): 72.8] [All Other OP (%BC): 72.8]","count":"1 through 10","median_amount":37604.06,"10th_percentile":37604.06,"90th_percentile":37604.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70.85] [OP Surgery  (%BC): 70.85] [Observation (%BC): 70.85] [Emergency Department (%BC): 70.85] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85]","count":"1 through 10","median_amount":41925.42,"10th_percentile":41925.42,"90th_percentile":42797.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":9505.16,"10th_percentile":9505.16,"90th_percentile":9505.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 71.54 Maximum Reimbursement 48190] [Cardiac Cath (%BC): 71.54 Maximum Reimbursement 54213] [Observation (%BC): 71.54 Maximum Reimbursement 15662] [Emergency Department (%BC): 71.54 Maximum Reimbursement 15662] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85 Charge Threshold 60000 (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":43077.33,"10th_percentile":43077.33,"90th_percentile":45075.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2388.13,"10th_percentile":2388.13,"90th_percentile":2388.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2279.12,"10th_percentile":2252.51,"90th_percentile":2346.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6710.25,"10th_percentile":6710.25,"90th_percentile":6793.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Strapping and Cast Application","code_information":[{"code":"5101","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Coventry/Non Gatekeeper Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72.8] [OP Surgery  (%BC): 72.8] [Observation (%BC): 72.8] [Emergency Department (%BC): 72.8] [Occupational Therapy (%BC): 72.8] [Physical Therapy (%BC): 72.8] [Respiratory Services/Therapy  (%BC): 72.8] [Speech Therapy (%BC): 72.8] [All Other OP (%BC): 72.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70.85] [OP Surgery  (%BC): 70.85] [Observation (%BC): 70.85] [Emergency Department (%BC): 70.85] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85]","count":"1 through 10","median_amount":1333.5,"10th_percentile":1124.39,"90th_percentile":4423.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 71.54 Maximum Reimbursement 48190] [Cardiac Cath (%BC): 71.54 Maximum Reimbursement 54213] [Observation (%BC): 71.54 Maximum Reimbursement 15662] [Emergency Department (%BC): 71.54 Maximum Reimbursement 15662] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85 Charge Threshold 60000 (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":1514.09,"10th_percentile":1514.09,"90th_percentile":1514.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":688.61,"10th_percentile":227.64,"90th_percentile":2321.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":454.06,"10th_percentile":292.86,"90th_percentile":1250.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Strapping and Cast Application","code_information":[{"code":"5102","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Coventry/Non Gatekeeper Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72.8] [OP Surgery  (%BC): 72.8] [Observation (%BC): 72.8] [Emergency Department (%BC): 72.8] [Occupational Therapy (%BC): 72.8] [Physical Therapy (%BC): 72.8] [Respiratory Services/Therapy  (%BC): 72.8] [Speech Therapy (%BC): 72.8] [All Other OP (%BC): 72.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70.85] [OP Surgery  (%BC): 70.85] [Observation (%BC): 70.85] [Emergency Department (%BC): 70.85] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 71.54 Maximum Reimbursement 48190] [Cardiac Cath (%BC): 71.54 Maximum Reimbursement 54213] [Observation (%BC): 71.54 Maximum Reimbursement 15662] [Emergency Department (%BC): 71.54 Maximum Reimbursement 15662] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85 Charge Threshold 60000 (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":237.1,"10th_percentile":237.1,"90th_percentile":237.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":821.16,"10th_percentile":821.16,"90th_percentile":821.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Musculoskeletal Procedures","code_information":[{"code":"5111","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Coventry/Non Gatekeeper Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72.8] [OP Surgery  (%BC): 72.8] [Observation (%BC): 72.8] [Emergency Department (%BC): 72.8] [Occupational Therapy (%BC): 72.8] [Physical Therapy (%BC): 72.8] [Respiratory Services/Therapy  (%BC): 72.8] [Speech Therapy (%BC): 72.8] [All Other OP (%BC): 72.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70.85] [OP Surgery  (%BC): 70.85] [Observation (%BC): 70.85] [Emergency Department (%BC): 70.85] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 71.54 Maximum Reimbursement 48190] [Cardiac Cath (%BC): 71.54 Maximum Reimbursement 54213] [Observation (%BC): 71.54 Maximum Reimbursement 15662] [Emergency Department (%BC): 71.54 Maximum Reimbursement 15662] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85 Charge Threshold 60000 (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":970.77,"10th_percentile":970.77,"90th_percentile":970.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":936.64,"10th_percentile":936.64,"90th_percentile":936.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Musculoskeletal Procedures","code_information":[{"code":"5112","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Coventry/Non Gatekeeper Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72.8] [OP Surgery  (%BC): 72.8] [Observation (%BC): 72.8] [Emergency Department (%BC): 72.8] [Occupational Therapy (%BC): 72.8] [Physical Therapy (%BC): 72.8] [Respiratory Services/Therapy  (%BC): 72.8] [Speech Therapy (%BC): 72.8] [All Other OP (%BC): 72.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70.85] [OP Surgery  (%BC): 70.85] [Observation (%BC): 70.85] [Emergency Department (%BC): 70.85] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85]","count":"1 through 10","median_amount":16452.9,"10th_percentile":16452.9,"90th_percentile":16452.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":562.58,"10th_percentile":562.58,"90th_percentile":562.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 71.54 Maximum Reimbursement 48190] [Cardiac Cath (%BC): 71.54 Maximum Reimbursement 54213] [Observation (%BC): 71.54 Maximum Reimbursement 15662] [Emergency Department (%BC): 71.54 Maximum Reimbursement 15662] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85 Charge Threshold 60000 (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":975.6,"10th_percentile":975.6,"90th_percentile":975.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Musculoskeletal Procedures","code_information":[{"code":"5113","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"16","median_amount":4046.22,"10th_percentile":2653.95,"90th_percentile":7048.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Coventry/Non Gatekeeper Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72.8] [OP Surgery  (%BC): 72.8] [Observation (%BC): 72.8] [Emergency Department (%BC): 72.8] [Occupational Therapy (%BC): 72.8] [Physical Therapy (%BC): 72.8] [Respiratory Services/Therapy  (%BC): 72.8] [Speech Therapy (%BC): 72.8] [All Other OP (%BC): 72.8]","count":"1 through 10","median_amount":19813.71,"10th_percentile":19813.71,"90th_percentile":19813.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70.85] [OP Surgery  (%BC): 70.85] [Observation (%BC): 70.85] [Emergency Department (%BC): 70.85] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85]","count":"45","median_amount":14911.68,"10th_percentile":12198.19,"90th_percentile":26629.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2764.3,"10th_percentile":2764.3,"90th_percentile":7280.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 71.54 Maximum Reimbursement 48190] [Cardiac Cath (%BC): 71.54 Maximum Reimbursement 54213] [Observation (%BC): 71.54 Maximum Reimbursement 15662] [Emergency Department (%BC): 71.54 Maximum Reimbursement 15662] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85 Charge Threshold 60000 (%BC): 70.85]","count":"1 through 10","median_amount":15892.54,"10th_percentile":15892.54,"90th_percentile":15892.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":12048.53,"10th_percentile":10143.4,"90th_percentile":20371.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":17762.99,"10th_percentile":17762.99,"90th_percentile":23651.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"18","median_amount":7185.27,"10th_percentile":2817.98,"90th_percentile":8176.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3328.13,"10th_percentile":3328.13,"90th_percentile":3328.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":3826.15,"10th_percentile":2764.3,"90th_percentile":4992.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"1 through 10","median_amount":22387.94,"10th_percentile":15824.75,"90th_percentile":36626.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"18","median_amount":3211.99,"10th_percentile":2784.27,"90th_percentile":3455.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Musculoskeletal Procedures","code_information":[{"code":"5114","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"17","median_amount":7307.48,"10th_percentile":6470.58,"90th_percentile":9571.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Coventry/Non Gatekeeper Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72.8] [OP Surgery  (%BC): 72.8] [Observation (%BC): 72.8] [Emergency Department (%BC): 72.8] [Occupational Therapy (%BC): 72.8] [Physical Therapy (%BC): 72.8] [Respiratory Services/Therapy  (%BC): 72.8] [Speech Therapy (%BC): 72.8] [All Other OP (%BC): 72.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70.85] [OP Surgery  (%BC): 70.85] [Observation (%BC): 70.85] [Emergency Department (%BC): 70.85] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85]","count":"28","median_amount":30995.76,"10th_percentile":23422.27,"90th_percentile":47665.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":6954.59,"10th_percentile":6949.55,"90th_percentile":9571.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"1 through 10","median_amount":29512.65,"10th_percentile":29512.65,"90th_percentile":29512.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 71.54 Maximum Reimbursement 48190] [Cardiac Cath (%BC): 71.54 Maximum Reimbursement 54213] [Observation (%BC): 71.54 Maximum Reimbursement 15662] [Emergency Department (%BC): 71.54 Maximum Reimbursement 15662] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85 Charge Threshold 60000 (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":28431.22,"10th_percentile":24027.69,"90th_percentile":38587.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"25","median_amount":7263.27,"10th_percentile":5397.3,"90th_percentile":10036.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7331.47,"10th_percentile":7331.47,"90th_percentile":7331.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":7307.48,"10th_percentile":7307.48,"90th_percentile":8960.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"1 through 10","median_amount":48796.02,"10th_percentile":38126.82,"90th_percentile":54235.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"11","median_amount":7299.8,"10th_percentile":5986.08,"90th_percentile":7558.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6766.99,"10th_percentile":6766.99,"90th_percentile":6766.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 5 Musculoskeletal Procedures","code_information":[{"code":"5115","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Coventry/Non Gatekeeper Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72.8] [OP Surgery  (%BC): 72.8] [Observation (%BC): 72.8] [Emergency Department (%BC): 72.8] [Occupational Therapy (%BC): 72.8] [Physical Therapy (%BC): 72.8] [Respiratory Services/Therapy  (%BC): 72.8] [Speech Therapy (%BC): 72.8] [All Other OP (%BC): 72.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70.85] [OP Surgery  (%BC): 70.85] [Observation (%BC): 70.85] [Emergency Department (%BC): 70.85] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85]","count":"1 through 10","median_amount":55306.93,"10th_percentile":27591.49,"90th_percentile":63136.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":14862.39,"10th_percentile":14862.39,"90th_percentile":14862.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 71.54 Maximum Reimbursement 48190] [Cardiac Cath (%BC): 71.54 Maximum Reimbursement 54213] [Observation (%BC): 71.54 Maximum Reimbursement 15662] [Emergency Department (%BC): 71.54 Maximum Reimbursement 15662] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85 Charge Threshold 60000 (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":79058.26,"10th_percentile":79058.26,"90th_percentile":79058.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":15150.98,"10th_percentile":12767.86,"90th_percentile":16875.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10515.5,"10th_percentile":10515.5,"90th_percentile":10515.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":13820.39,"10th_percentile":13820.39,"90th_percentile":13820.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":13582.36,"10th_percentile":13582.36,"90th_percentile":13582.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 6 Musculoskeletal Procedures","code_information":[{"code":"5116","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Coventry/Non Gatekeeper Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72.8] [OP Surgery  (%BC): 72.8] [Observation (%BC): 72.8] [Emergency Department (%BC): 72.8] [Occupational Therapy (%BC): 72.8] [Physical Therapy (%BC): 72.8] [Respiratory Services/Therapy  (%BC): 72.8] [Speech Therapy (%BC): 72.8] [All Other OP (%BC): 72.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70.85] [OP Surgery  (%BC): 70.85] [Observation (%BC): 70.85] [Emergency Department (%BC): 70.85] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85]","count":"1 through 10","median_amount":2649.68,"10th_percentile":2649.68,"90th_percentile":2649.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 71.54 Maximum Reimbursement 48190] [Cardiac Cath (%BC): 71.54 Maximum Reimbursement 54213] [Observation (%BC): 71.54 Maximum Reimbursement 15662] [Emergency Department (%BC): 71.54 Maximum Reimbursement 15662] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85 Charge Threshold 60000 (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":22393.86,"10th_percentile":22393.86,"90th_percentile":22393.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":19170.16,"10th_percentile":19170.16,"90th_percentile":19170.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Airway Endoscopy","code_information":[{"code":"5153","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Coventry/Non Gatekeeper Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72.8] [OP Surgery  (%BC): 72.8] [Observation (%BC): 72.8] [Emergency Department (%BC): 72.8] [Occupational Therapy (%BC): 72.8] [Physical Therapy (%BC): 72.8] [Respiratory Services/Therapy  (%BC): 72.8] [Speech Therapy (%BC): 72.8] [All Other OP (%BC): 72.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70.85] [OP Surgery  (%BC): 70.85] [Observation (%BC): 70.85] [Emergency Department (%BC): 70.85] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 71.54 Maximum Reimbursement 48190] [Cardiac Cath (%BC): 71.54 Maximum Reimbursement 54213] [Observation (%BC): 71.54 Maximum Reimbursement 15662] [Emergency Department (%BC): 71.54 Maximum Reimbursement 15662] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85 Charge Threshold 60000 (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":12221.19,"10th_percentile":12221.19,"90th_percentile":12221.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 ENT Procedures","code_information":[{"code":"5161","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Coventry/Non Gatekeeper Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72.8] [OP Surgery  (%BC): 72.8] [Observation (%BC): 72.8] [Emergency Department (%BC): 72.8] [Occupational Therapy (%BC): 72.8] [Physical Therapy (%BC): 72.8] [Respiratory Services/Therapy  (%BC): 72.8] [Speech Therapy (%BC): 72.8] [All Other OP (%BC): 72.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70.85] [OP Surgery  (%BC): 70.85] [Observation (%BC): 70.85] [Emergency Department (%BC): 70.85] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 71.54 Maximum Reimbursement 48190] [Cardiac Cath (%BC): 71.54 Maximum Reimbursement 54213] [Observation (%BC): 71.54 Maximum Reimbursement 15662] [Emergency Department (%BC): 71.54 Maximum Reimbursement 15662] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85 Charge Threshold 60000 (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2580.62,"10th_percentile":2580.62,"90th_percentile":2580.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Vascular Procedures","code_information":[{"code":"5182","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Coventry/Non Gatekeeper Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72.8] [OP Surgery  (%BC): 72.8] [Observation (%BC): 72.8] [Emergency Department (%BC): 72.8] [Occupational Therapy (%BC): 72.8] [Physical Therapy (%BC): 72.8] [Respiratory Services/Therapy  (%BC): 72.8] [Speech Therapy (%BC): 72.8] [All Other OP (%BC): 72.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70.85] [OP Surgery  (%BC): 70.85] [Observation (%BC): 70.85] [Emergency Department (%BC): 70.85] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":4006.34,"10th_percentile":4006.34,"90th_percentile":4006.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 71.54 Maximum Reimbursement 48190] [Cardiac Cath (%BC): 71.54 Maximum Reimbursement 54213] [Observation (%BC): 71.54 Maximum Reimbursement 15662] [Emergency Department (%BC): 71.54 Maximum Reimbursement 15662] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85 Charge Threshold 60000 (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":933.1,"10th_percentile":933.1,"90th_percentile":933.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1269.56,"10th_percentile":1269.56,"90th_percentile":1269.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2209.38,"10th_percentile":2209.38,"90th_percentile":2209.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1586.96,"10th_percentile":1586.96,"90th_percentile":1586.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Vascular Procedures","code_information":[{"code":"5183","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2474.73,"10th_percentile":2474.73,"90th_percentile":2474.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Coventry/Non Gatekeeper Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72.8] [OP Surgery  (%BC): 72.8] [Observation (%BC): 72.8] [Emergency Department (%BC): 72.8] [Occupational Therapy (%BC): 72.8] [Physical Therapy (%BC): 72.8] [Respiratory Services/Therapy  (%BC): 72.8] [Speech Therapy (%BC): 72.8] [All Other OP (%BC): 72.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70.85] [OP Surgery  (%BC): 70.85] [Observation (%BC): 70.85] [Emergency Department (%BC): 70.85] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85]","count":"1 through 10","median_amount":16055.0,"10th_percentile":16055.0,"90th_percentile":17950.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 71.54 Maximum Reimbursement 48190] [Cardiac Cath (%BC): 71.54 Maximum Reimbursement 54213] [Observation (%BC): 71.54 Maximum Reimbursement 15662] [Emergency Department (%BC): 71.54 Maximum Reimbursement 15662] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85 Charge Threshold 60000 (%BC): 70.85]","count":"1 through 10","median_amount":16746.0,"10th_percentile":16746.0,"90th_percentile":16746.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":23535.64,"10th_percentile":23535.64,"90th_percentile":23535.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2794.02,"10th_percentile":2682.49,"90th_percentile":3626.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":3169.11,"10th_percentile":3169.11,"90th_percentile":3169.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3108.82,"10th_percentile":3108.82,"90th_percentile":3344.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Blood Product Exchange and Related Services","code_information":[{"code":"5241","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Coventry/Non Gatekeeper Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72.8] [OP Surgery  (%BC): 72.8] [Observation (%BC): 72.8] [Emergency Department (%BC): 72.8] [Occupational Therapy (%BC): 72.8] [Physical Therapy (%BC): 72.8] [Respiratory Services/Therapy  (%BC): 72.8] [Speech Therapy (%BC): 72.8] [All Other OP (%BC): 72.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70.85] [OP Surgery  (%BC): 70.85] [Observation (%BC): 70.85] [Emergency Department (%BC): 70.85] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85]","count":"1 through 10","median_amount":5388.15,"10th_percentile":5388.15,"90th_percentile":5388.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2150.84,"10th_percentile":2150.84,"90th_percentile":2150.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 71.54 Maximum Reimbursement 48190] [Cardiac Cath (%BC): 71.54 Maximum Reimbursement 54213] [Observation (%BC): 71.54 Maximum Reimbursement 15662] [Emergency Department (%BC): 71.54 Maximum Reimbursement 15662] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85 Charge Threshold 60000 (%BC): 70.85]","count":"1 through 10","median_amount":15178.5,"10th_percentile":15178.5,"90th_percentile":15178.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":15976.93,"10th_percentile":15976.93,"90th_percentile":15976.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Upper GI Procedures","code_information":[{"code":"5301","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Coventry/Non Gatekeeper Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72.8] [OP Surgery  (%BC): 72.8] [Observation (%BC): 72.8] [Emergency Department (%BC): 72.8] [Occupational Therapy (%BC): 72.8] [Physical Therapy (%BC): 72.8] [Respiratory Services/Therapy  (%BC): 72.8] [Speech Therapy (%BC): 72.8] [All Other OP (%BC): 72.8]","count":"1 through 10","median_amount":7062.91,"10th_percentile":7062.91,"90th_percentile":7821.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70.85] [OP Surgery  (%BC): 70.85] [Observation (%BC): 70.85] [Emergency Department (%BC): 70.85] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85]","count":"171","median_amount":6998.27,"10th_percentile":5295.7,"90th_percentile":12115.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"48","median_amount":1247.46,"10th_percentile":1197.66,"90th_percentile":1247.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"1 through 10","median_amount":6913.61,"10th_percentile":4638.82,"90th_percentile":10397.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 71.54 Maximum Reimbursement 48190] [Cardiac Cath (%BC): 71.54 Maximum Reimbursement 54213] [Observation (%BC): 71.54 Maximum Reimbursement 15662] [Emergency Department (%BC): 71.54 Maximum Reimbursement 15662] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85 Charge Threshold 60000 (%BC): 70.85]","count":"1 through 10","median_amount":5991.97,"10th_percentile":5160.3,"90th_percentile":13334.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"35","median_amount":6422.43,"10th_percentile":5630.45,"90th_percentile":8560.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":7165.23,"10th_percentile":6171.51,"90th_percentile":8038.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"96","median_amount":1271.69,"10th_percentile":1202.52,"90th_percentile":1271.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":961.92,"10th_percentile":961.69,"90th_percentile":1233.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"53","median_amount":1247.46,"10th_percentile":1179.62,"90th_percentile":1247.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":3735.68,"10th_percentile":3735.68,"90th_percentile":3735.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"21","median_amount":8163.21,"10th_percentile":5848.57,"90th_percentile":14470.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"84","median_amount":996.1,"10th_percentile":700.84,"90th_percentile":1237.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"38","median_amount":977.33,"10th_percentile":874.46,"90th_percentile":1452.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Upper GI Procedures","code_information":[{"code":"5302","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Coventry/Non Gatekeeper Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72.8] [OP Surgery  (%BC): 72.8] [Observation (%BC): 72.8] [Emergency Department (%BC): 72.8] [Occupational Therapy (%BC): 72.8] [Physical Therapy (%BC): 72.8] [Respiratory Services/Therapy  (%BC): 72.8] [Speech Therapy (%BC): 72.8] [All Other OP (%BC): 72.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70.85] [OP Surgery  (%BC): 70.85] [Observation (%BC): 70.85] [Emergency Department (%BC): 70.85] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85]","count":"1 through 10","median_amount":7000.7,"10th_percentile":6816.6,"90th_percentile":13940.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 71.54 Maximum Reimbursement 48190] [Cardiac Cath (%BC): 71.54 Maximum Reimbursement 54213] [Observation (%BC): 71.54 Maximum Reimbursement 15662] [Emergency Department (%BC): 71.54 Maximum Reimbursement 15662] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85 Charge Threshold 60000 (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":7628.26,"10th_percentile":7628.26,"90th_percentile":7628.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1871.2,"10th_percentile":1871.2,"90th_percentile":1871.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"1 through 10","median_amount":10321.25,"10th_percentile":10321.25,"90th_percentile":16579.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1990.2,"10th_percentile":1972.53,"90th_percentile":2020.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1977.46,"10th_percentile":1977.46,"90th_percentile":1977.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Upper GI Procedures","code_information":[{"code":"5303","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Coventry/Non Gatekeeper Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72.8] [OP Surgery  (%BC): 72.8] [Observation (%BC): 72.8] [Emergency Department (%BC): 72.8] [Occupational Therapy (%BC): 72.8] [Physical Therapy (%BC): 72.8] [Respiratory Services/Therapy  (%BC): 72.8] [Speech Therapy (%BC): 72.8] [All Other OP (%BC): 72.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70.85] [OP Surgery  (%BC): 70.85] [Observation (%BC): 70.85] [Emergency Department (%BC): 70.85] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85]","count":"1 through 10","median_amount":21090.85,"10th_percentile":21090.85,"90th_percentile":21090.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 71.54 Maximum Reimbursement 48190] [Cardiac Cath (%BC): 71.54 Maximum Reimbursement 54213] [Observation (%BC): 71.54 Maximum Reimbursement 15662] [Emergency Department (%BC): 71.54 Maximum Reimbursement 15662] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85 Charge Threshold 60000 (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":6363.7,"10th_percentile":6363.7,"90th_percentile":6363.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Lower GI Procedures","code_information":[{"code":"5311","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"17","median_amount":1274.68,"10th_percentile":1205.35,"90th_percentile":1274.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Coventry/Non Gatekeeper Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72.8] [OP Surgery  (%BC): 72.8] [Observation (%BC): 72.8] [Emergency Department (%BC): 72.8] [Occupational Therapy (%BC): 72.8] [Physical Therapy (%BC): 72.8] [Respiratory Services/Therapy  (%BC): 72.8] [Speech Therapy (%BC): 72.8] [All Other OP (%BC): 72.8]","count":"1 through 10","median_amount":7075.4,"10th_percentile":7075.4,"90th_percentile":7075.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70.85] [OP Surgery  (%BC): 70.85] [Observation (%BC): 70.85] [Emergency Department (%BC): 70.85] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85]","count":"137","median_amount":7292.38,"10th_percentile":6546.45,"90th_percentile":10984.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1274.68,"10th_percentile":1274.68,"90th_percentile":1274.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"1 through 10","median_amount":7262.03,"10th_percentile":6903.39,"90th_percentile":11080.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 71.54 Maximum Reimbursement 48190] [Cardiac Cath (%BC): 71.54 Maximum Reimbursement 54213] [Observation (%BC): 71.54 Maximum Reimbursement 15662] [Emergency Department (%BC): 71.54 Maximum Reimbursement 15662] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85 Charge Threshold 60000 (%BC): 70.85]","count":"1 through 10","median_amount":7474.79,"10th_percentile":6947.33,"90th_percentile":10759.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"30","median_amount":7201.36,"10th_percentile":6643.08,"90th_percentile":9478.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":12199.83,"10th_percentile":8893.19,"90th_percentile":13069.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"40","median_amount":1299.43,"10th_percentile":1228.75,"90th_percentile":1299.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1283.17,"10th_percentile":1283.17,"90th_percentile":1283.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1223.79,"10th_percentile":1223.79,"90th_percentile":3134.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":6377.96,"10th_percentile":6377.96,"90th_percentile":6377.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"22","median_amount":8355.59,"10th_percentile":7123.32,"90th_percentile":10962.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"33","median_amount":968.64,"10th_percentile":931.38,"90th_percentile":1313.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"34","median_amount":951.25,"10th_percentile":883.27,"90th_percentile":975.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Lower GI Procedures","code_information":[{"code":"5312","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"20","median_amount":1274.68,"10th_percentile":1205.35,"90th_percentile":3134.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Coventry/Non Gatekeeper Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72.8] [OP Surgery  (%BC): 72.8] [Observation (%BC): 72.8] [Emergency Department (%BC): 72.8] [Occupational Therapy (%BC): 72.8] [Physical Therapy (%BC): 72.8] [Respiratory Services/Therapy  (%BC): 72.8] [Speech Therapy (%BC): 72.8] [All Other OP (%BC): 72.8]","count":"1 through 10","median_amount":7411.19,"10th_percentile":7411.19,"90th_percentile":7411.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70.85] [OP Surgery  (%BC): 70.85] [Observation (%BC): 70.85] [Emergency Department (%BC): 70.85] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85]","count":"156","median_amount":9399.54,"10th_percentile":7668.07,"90th_percentile":13668.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"20","median_amount":1912.02,"10th_percentile":1274.68,"90th_percentile":3134.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"1 through 10","median_amount":12998.6,"10th_percentile":9373.7,"90th_percentile":14486.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 71.54 Maximum Reimbursement 48190] [Cardiac Cath (%BC): 71.54 Maximum Reimbursement 54213] [Observation (%BC): 71.54 Maximum Reimbursement 15662] [Emergency Department (%BC): 71.54 Maximum Reimbursement 15662] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85 Charge Threshold 60000 (%BC): 70.85]","count":"1 through 10","median_amount":13418.18,"10th_percentile":13418.18,"90th_percentile":14791.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"26","median_amount":11149.5,"10th_percentile":7719.94,"90th_percentile":15596.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"13","median_amount":9941.79,"10th_percentile":7772.4,"90th_percentile":14861.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"54","median_amount":1299.43,"10th_percentile":1228.75,"90th_percentile":1949.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1692.78,"10th_percentile":1211.25,"90th_percentile":1969.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"13","median_amount":1274.68,"10th_percentile":1205.35,"90th_percentile":1912.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1229.1,"10th_percentile":1229.1,"90th_percentile":1229.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"29","median_amount":11653.67,"10th_percentile":7844.61,"90th_percentile":17610.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"51","median_amount":1515.56,"10th_percentile":1205.42,"90th_percentile":2334.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"24","median_amount":1254.0,"10th_percentile":1229.1,"90th_percentile":2111.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Lower GI Procedures","code_information":[{"code":"5313","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Coventry/Non Gatekeeper Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72.8] [OP Surgery  (%BC): 72.8] [Observation (%BC): 72.8] [Emergency Department (%BC): 72.8] [Occupational Therapy (%BC): 72.8] [Physical Therapy (%BC): 72.8] [Respiratory Services/Therapy  (%BC): 72.8] [Speech Therapy (%BC): 72.8] [All Other OP (%BC): 72.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70.85] [OP Surgery  (%BC): 70.85] [Observation (%BC): 70.85] [Emergency Department (%BC): 70.85] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85]","count":"1 through 10","median_amount":27136.21,"10th_percentile":27136.21,"90th_percentile":27136.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 71.54 Maximum Reimbursement 48190] [Cardiac Cath (%BC): 71.54 Maximum Reimbursement 54213] [Observation (%BC): 71.54 Maximum Reimbursement 15662] [Emergency Department (%BC): 71.54 Maximum Reimbursement 15662] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85 Charge Threshold 60000 (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2804.83,"10th_percentile":2804.83,"90th_percentile":2804.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":3405.41,"10th_percentile":3405.41,"90th_percentile":3405.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"1 through 10","median_amount":12673.03,"10th_percentile":12673.03,"90th_percentile":12673.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Abdominal/Peritoneal/Biliary and Related Procedures","code_information":[{"code":"5341","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Coventry/Non Gatekeeper Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72.8] [OP Surgery  (%BC): 72.8] [Observation (%BC): 72.8] [Emergency Department (%BC): 72.8] [Occupational Therapy (%BC): 72.8] [Physical Therapy (%BC): 72.8] [Respiratory Services/Therapy  (%BC): 72.8] [Speech Therapy (%BC): 72.8] [All Other OP (%BC): 72.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70.85] [OP Surgery  (%BC): 70.85] [Observation (%BC): 70.85] [Emergency Department (%BC): 70.85] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85]","count":"1 through 10","median_amount":23997.02,"10th_percentile":23997.02,"90th_percentile":35837.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 71.54 Maximum Reimbursement 48190] [Cardiac Cath (%BC): 71.54 Maximum Reimbursement 54213] [Observation (%BC): 71.54 Maximum Reimbursement 15662] [Emergency Department (%BC): 71.54 Maximum Reimbursement 15662] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85 Charge Threshold 60000 (%BC): 70.85]","count":"1 through 10","median_amount":33997.73,"10th_percentile":33997.73,"90th_percentile":33997.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":7295.13,"10th_percentile":7295.13,"90th_percentile":7295.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"1 through 10","median_amount":22547.1,"10th_percentile":22547.1,"90th_percentile":22547.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4160.67,"10th_percentile":4160.67,"90th_percentile":4160.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Abdominal/Peritoneal/Biliary and Related Procedures","code_information":[{"code":"5342","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Coventry/Non Gatekeeper Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72.8] [OP Surgery  (%BC): 72.8] [Observation (%BC): 72.8] [Emergency Department (%BC): 72.8] [Occupational Therapy (%BC): 72.8] [Physical Therapy (%BC): 72.8] [Respiratory Services/Therapy  (%BC): 72.8] [Speech Therapy (%BC): 72.8] [All Other OP (%BC): 72.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70.85] [OP Surgery  (%BC): 70.85] [Observation (%BC): 70.85] [Emergency Department (%BC): 70.85] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85]","count":"1 through 10","median_amount":26315.68,"10th_percentile":26315.68,"90th_percentile":26315.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 71.54 Maximum Reimbursement 48190] [Cardiac Cath (%BC): 71.54 Maximum Reimbursement 54213] [Observation (%BC): 71.54 Maximum Reimbursement 15662] [Emergency Department (%BC): 71.54 Maximum Reimbursement 15662] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85 Charge Threshold 60000 (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Laparoscopy and Related Services","code_information":[{"code":"5361","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":4263.71,"10th_percentile":4199.44,"90th_percentile":4665.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Coventry/Non Gatekeeper Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72.8] [OP Surgery  (%BC): 72.8] [Observation (%BC): 72.8] [Emergency Department (%BC): 72.8] [Occupational Therapy (%BC): 72.8] [Physical Therapy (%BC): 72.8] [Respiratory Services/Therapy  (%BC): 72.8] [Speech Therapy (%BC): 72.8] [All Other OP (%BC): 72.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70.85] [OP Surgery  (%BC): 70.85] [Observation (%BC): 70.85] [Emergency Department (%BC): 70.85] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85]","count":"28","median_amount":29381.28,"10th_percentile":24880.46,"90th_percentile":44479.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5181.44,"10th_percentile":4263.71,"90th_percentile":5629.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 71.54 Maximum Reimbursement 48190] [Cardiac Cath (%BC): 71.54 Maximum Reimbursement 54213] [Observation (%BC): 71.54 Maximum Reimbursement 15662] [Emergency Department (%BC): 71.54 Maximum Reimbursement 15662] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85 Charge Threshold 60000 (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":34887.85,"10th_percentile":27920.39,"90th_percentile":73923.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":30775.38,"10th_percentile":30775.38,"90th_percentile":39380.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"12","median_amount":4346.5,"10th_percentile":4280.99,"90th_percentile":4928.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":4263.71,"10th_percentile":4199.44,"90th_percentile":4440.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"1 through 10","median_amount":32513.59,"10th_percentile":32513.59,"90th_percentile":32513.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5006.58,"10th_percentile":4755.63,"90th_percentile":5491.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5488.38,"10th_percentile":5488.38,"90th_percentile":5488.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Laparoscopy and Related Services","code_information":[{"code":"5362","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Coventry/Non Gatekeeper Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72.8] [OP Surgery  (%BC): 72.8] [Observation (%BC): 72.8] [Emergency Department (%BC): 72.8] [Occupational Therapy (%BC): 72.8] [Physical Therapy (%BC): 72.8] [Respiratory Services/Therapy  (%BC): 72.8] [Speech Therapy (%BC): 72.8] [All Other OP (%BC): 72.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70.85] [OP Surgery  (%BC): 70.85] [Observation (%BC): 70.85] [Emergency Department (%BC): 70.85] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85]","count":"1 through 10","median_amount":45109.15,"10th_percentile":44577.73,"90th_percentile":68227.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":10582.8,"10th_percentile":10582.8,"90th_percentile":10582.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 71.54 Maximum Reimbursement 48190] [Cardiac Cath (%BC): 71.54 Maximum Reimbursement 54213] [Observation (%BC): 71.54 Maximum Reimbursement 15662] [Emergency Department (%BC): 71.54 Maximum Reimbursement 15662] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85 Charge Threshold 60000 (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":44278.07,"10th_percentile":44278.07,"90th_percentile":44278.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":12205.38,"10th_percentile":12205.38,"90th_percentile":12205.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"1 through 10","median_amount":66227.55,"10th_percentile":66227.55,"90th_percentile":66227.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Urology and Related Services","code_information":[{"code":"5371","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":233.89,"10th_percentile":233.89,"90th_percentile":233.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Coventry/Non Gatekeeper Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72.8] [OP Surgery  (%BC): 72.8] [Observation (%BC): 72.8] [Emergency Department (%BC): 72.8] [Occupational Therapy (%BC): 72.8] [Physical Therapy (%BC): 72.8] [Respiratory Services/Therapy  (%BC): 72.8] [Speech Therapy (%BC): 72.8] [All Other OP (%BC): 72.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70.85] [OP Surgery  (%BC): 70.85] [Observation (%BC): 70.85] [Emergency Department (%BC): 70.85] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85]","count":"1 through 10","median_amount":3816.07,"10th_percentile":3816.07,"90th_percentile":3816.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":233.89,"10th_percentile":233.89,"90th_percentile":233.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 71.54 Maximum Reimbursement 48190] [Cardiac Cath (%BC): 71.54 Maximum Reimbursement 54213] [Observation (%BC): 71.54 Maximum Reimbursement 15662] [Emergency Department (%BC): 71.54 Maximum Reimbursement 15662] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85 Charge Threshold 60000 (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":238.43,"10th_percentile":238.43,"90th_percentile":378.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":361.2,"10th_percentile":361.2,"90th_percentile":361.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 71.54 Maximum Reimbursement 48190] [Cardiac Cath (%BC): 71.54 Maximum Reimbursement 54213] [Observation (%BC): 71.54 Maximum Reimbursement 15662] [Emergency Department (%BC): 71.54 Maximum Reimbursement 15662] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85 Charge Threshold 60000 (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":232.18,"10th_percentile":232.18,"90th_percentile":232.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":232.18,"10th_percentile":232.18,"90th_percentile":232.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Gynecologic Procedures","code_information":[{"code":"5414","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2979.51,"10th_percentile":2979.51,"90th_percentile":2979.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Coventry/Non Gatekeeper Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72.8] [OP Surgery  (%BC): 72.8] [Observation (%BC): 72.8] [Emergency Department (%BC): 72.8] [Occupational Therapy (%BC): 72.8] [Physical Therapy (%BC): 72.8] [Respiratory Services/Therapy  (%BC): 72.8] [Speech Therapy (%BC): 72.8] [All Other OP (%BC): 72.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70.85] [OP Surgery  (%BC): 70.85] [Observation (%BC): 70.85] [Emergency Department (%BC): 70.85] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85]","count":"1 through 10","median_amount":18821.32,"10th_percentile":18821.32,"90th_percentile":18821.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2842.67,"10th_percentile":2842.67,"90th_percentile":2842.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 71.54 Maximum Reimbursement 48190] [Cardiac Cath (%BC): 71.54 Maximum Reimbursement 54213] [Observation (%BC): 71.54 Maximum Reimbursement 15662] [Emergency Department (%BC): 71.54 Maximum Reimbursement 15662] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85 Charge Threshold 60000 (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":17390.96,"10th_percentile":17390.96,"90th_percentile":17390.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2685.39,"10th_percentile":2685.39,"90th_percentile":2685.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2980.08,"10th_percentile":2980.08,"90th_percentile":2980.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 5 Gynecologic Procedures","code_information":[{"code":"5415","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Coventry/Non Gatekeeper Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72.8] [OP Surgery  (%BC): 72.8] [Observation (%BC): 72.8] [Emergency Department (%BC): 72.8] [Occupational Therapy (%BC): 72.8] [Physical Therapy (%BC): 72.8] [Respiratory Services/Therapy  (%BC): 72.8] [Speech Therapy (%BC): 72.8] [All Other OP (%BC): 72.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70.85] [OP Surgery  (%BC): 70.85] [Observation (%BC): 70.85] [Emergency Department (%BC): 70.85] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2886.17,"10th_percentile":2886.17,"90th_percentile":2886.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 71.54 Maximum Reimbursement 48190] [Cardiac Cath (%BC): 71.54 Maximum Reimbursement 54213] [Observation (%BC): 71.54 Maximum Reimbursement 15662] [Emergency Department (%BC): 71.54 Maximum Reimbursement 15662] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85 Charge Threshold 60000 (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":3061.72,"10th_percentile":3061.72,"90th_percentile":3061.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"1 through 10","median_amount":40644.18,"10th_percentile":40644.18,"90th_percentile":40644.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Nerve Procedures","code_information":[{"code":"5431","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2482.58,"10th_percentile":2482.58,"90th_percentile":2482.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Coventry/Non Gatekeeper Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72.8] [OP Surgery  (%BC): 72.8] [Observation (%BC): 72.8] [Emergency Department (%BC): 72.8] [Occupational Therapy (%BC): 72.8] [Physical Therapy (%BC): 72.8] [Respiratory Services/Therapy  (%BC): 72.8] [Speech Therapy (%BC): 72.8] [All Other OP (%BC): 72.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70.85] [OP Surgery  (%BC): 70.85] [Observation (%BC): 70.85] [Emergency Department (%BC): 70.85] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85]","count":"1 through 10","median_amount":15096.9,"10th_percentile":12778.25,"90th_percentile":39386.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2383.47,"10th_percentile":1588.98,"90th_percentile":2482.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 71.54 Maximum Reimbursement 48190] [Cardiac Cath (%BC): 71.54 Maximum Reimbursement 54213] [Observation (%BC): 71.54 Maximum Reimbursement 15662] [Emergency Department (%BC): 71.54 Maximum Reimbursement 15662] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85 Charge Threshold 60000 (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":13695.62,"10th_percentile":13695.62,"90th_percentile":13695.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2530.78,"10th_percentile":2429.75,"90th_percentile":2530.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2347.55,"10th_percentile":2347.55,"90th_percentile":4316.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"1 through 10","median_amount":13055.17,"10th_percentile":13055.17,"90th_percentile":13055.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1824.58,"10th_percentile":1756.19,"90th_percentile":2081.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1813.36,"10th_percentile":1813.36,"90th_percentile":2035.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Nerve Injections","code_information":[{"code":"5441","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":318.41,"10th_percentile":318.41,"90th_percentile":708.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Coventry/Non Gatekeeper Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72.8] [OP Surgery  (%BC): 72.8] [Observation (%BC): 72.8] [Emergency Department (%BC): 72.8] [Occupational Therapy (%BC): 72.8] [Physical Therapy (%BC): 72.8] [Respiratory Services/Therapy  (%BC): 72.8] [Speech Therapy (%BC): 72.8] [All Other OP (%BC): 72.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70.85] [OP Surgery  (%BC): 70.85] [Observation (%BC): 70.85] [Emergency Department (%BC): 70.85] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85]","count":"13","median_amount":1890.67,"10th_percentile":1059.59,"90th_percentile":2459.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":318.41,"10th_percentile":318.41,"90th_percentile":318.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 71.54 Maximum Reimbursement 48190] [Cardiac Cath (%BC): 71.54 Maximum Reimbursement 54213] [Observation (%BC): 71.54 Maximum Reimbursement 15662] [Emergency Department (%BC): 71.54 Maximum Reimbursement 15662] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85 Charge Threshold 60000 (%BC): 70.85]","count":"1 through 10","median_amount":1932.58,"10th_percentile":1932.58,"90th_percentile":1932.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":2206.61,"10th_percentile":2206.61,"90th_percentile":2206.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":657.77,"10th_percentile":657.77,"90th_percentile":657.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"1 through 10","median_amount":2429.39,"10th_percentile":2429.39,"90th_percentile":2429.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"13","median_amount":301.56,"10th_percentile":258.97,"90th_percentile":518.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":317.31,"10th_percentile":278.45,"90th_percentile":576.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Nerve Injections","code_information":[{"code":"5442","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":988.13,"10th_percentile":988.13,"90th_percentile":988.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Coventry/Non Gatekeeper Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72.8] [OP Surgery  (%BC): 72.8] [Observation (%BC): 72.8] [Emergency Department (%BC): 72.8] [Occupational Therapy (%BC): 72.8] [Physical Therapy (%BC): 72.8] [Respiratory Services/Therapy  (%BC): 72.8] [Speech Therapy (%BC): 72.8] [All Other OP (%BC): 72.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70.85] [OP Surgery  (%BC): 70.85] [Observation (%BC): 70.85] [Emergency Department (%BC): 70.85] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85]","count":"1 through 10","median_amount":8715.26,"10th_percentile":3271.43,"90th_percentile":10152.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":948.68,"10th_percentile":773.97,"90th_percentile":988.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"1 through 10","median_amount":7701.8,"10th_percentile":7701.8,"90th_percentile":7701.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 71.54 Maximum Reimbursement 48190] [Cardiac Cath (%BC): 71.54 Maximum Reimbursement 54213] [Observation (%BC): 71.54 Maximum Reimbursement 15662] [Emergency Department (%BC): 71.54 Maximum Reimbursement 15662] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85 Charge Threshold 60000 (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":8777.65,"10th_percentile":8321.73,"90th_percentile":56839.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":967.1,"10th_percentile":952.53,"90th_percentile":1007.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":948.68,"10th_percentile":515.99,"90th_percentile":988.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":594.28,"10th_percentile":500.57,"90th_percentile":1144.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":721.9,"10th_percentile":721.9,"90th_percentile":821.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Nerve Injections","code_information":[{"code":"5443","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"49","median_amount":1482.19,"10th_percentile":988.13,"90th_percentile":1482.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Coventry/Non Gatekeeper Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72.8] [OP Surgery  (%BC): 72.8] [Observation (%BC): 72.8] [Emergency Department (%BC): 72.8] [Occupational Therapy (%BC): 72.8] [Physical Therapy (%BC): 72.8] [Respiratory Services/Therapy  (%BC): 72.8] [Speech Therapy (%BC): 72.8] [All Other OP (%BC): 72.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70.85] [OP Surgery  (%BC): 70.85] [Observation (%BC): 70.85] [Emergency Department (%BC): 70.85] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85]","count":"44","median_amount":8629.58,"10th_percentile":7249.73,"90th_percentile":9760.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"26","median_amount":1401.57,"10th_percentile":5.67,"90th_percentile":1482.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"1 through 10","median_amount":8999.94,"10th_percentile":8890.94,"90th_percentile":10061.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 71.54 Maximum Reimbursement 48190] [Cardiac Cath (%BC): 71.54 Maximum Reimbursement 54213] [Observation (%BC): 71.54 Maximum Reimbursement 15662] [Emergency Department (%BC): 71.54 Maximum Reimbursement 15662] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85 Charge Threshold 60000 (%BC): 70.85]","count":"1 through 10","median_amount":7238.31,"10th_percentile":7238.31,"90th_percentile":9033.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"13","median_amount":8799.8,"10th_percentile":8072.15,"90th_percentile":9795.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":11498.02,"10th_percentile":11498.02,"90th_percentile":11498.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"36","median_amount":1450.65,"10th_percentile":967.1,"90th_percentile":1510.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1372.75,"10th_percentile":1372.75,"90th_percentile":1372.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"29","median_amount":1482.19,"10th_percentile":948.68,"90th_percentile":1482.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":856.1,"10th_percentile":856.1,"90th_percentile":856.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"1 through 10","median_amount":9771.1,"10th_percentile":8752.42,"90th_percentile":11273.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"26","median_amount":1057.2,"10th_percentile":628.27,"90th_percentile":1221.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"30","median_amount":1392.08,"10th_percentile":928.06,"90th_percentile":1392.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Neurostimulator and Related Procedures","code_information":[{"code":"5462","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":9631.61,"10th_percentile":9631.61,"90th_percentile":9631.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Coventry/Non Gatekeeper Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72.8] [OP Surgery  (%BC): 72.8] [Observation (%BC): 72.8] [Emergency Department (%BC): 72.8] [Occupational Therapy (%BC): 72.8] [Physical Therapy (%BC): 72.8] [Respiratory Services/Therapy  (%BC): 72.8] [Speech Therapy (%BC): 72.8] [All Other OP (%BC): 72.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70.85] [OP Surgery  (%BC): 70.85] [Observation (%BC): 70.85] [Emergency Department (%BC): 70.85] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":7909.0,"10th_percentile":7909.0,"90th_percentile":7909.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 71.54 Maximum Reimbursement 48190] [Cardiac Cath (%BC): 71.54 Maximum Reimbursement 54213] [Observation (%BC): 71.54 Maximum Reimbursement 15662] [Emergency Department (%BC): 71.54 Maximum Reimbursement 15662] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85 Charge Threshold 60000 (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":9650.73,"10th_percentile":9650.73,"90th_percentile":9650.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6684.48,"10th_percentile":5287.6,"90th_percentile":7000.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6841.3,"10th_percentile":6841.3,"90th_percentile":6841.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 5 Neurostimulator and Related Procedures","code_information":[{"code":"5465","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Coventry/Non Gatekeeper Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72.8] [OP Surgery  (%BC): 72.8] [Observation (%BC): 72.8] [Emergency Department (%BC): 72.8] [Occupational Therapy (%BC): 72.8] [Physical Therapy (%BC): 72.8] [Respiratory Services/Therapy  (%BC): 72.8] [Speech Therapy (%BC): 72.8] [All Other OP (%BC): 72.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70.85] [OP Surgery  (%BC): 70.85] [Observation (%BC): 70.85] [Emergency Department (%BC): 70.85] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 71.54 Maximum Reimbursement 48190] [Cardiac Cath (%BC): 71.54 Maximum Reimbursement 54213] [Observation (%BC): 71.54 Maximum Reimbursement 15662] [Emergency Department (%BC): 71.54 Maximum Reimbursement 15662] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85 Charge Threshold 60000 (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":32477.41,"10th_percentile":32477.41,"90th_percentile":32477.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Imaging without Contrast","code_information":[{"code":"5521","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"203","median_amount":108.96,"10th_percentile":69.74,"90th_percentile":373.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Coventry/Non Gatekeeper Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72.8] [OP Surgery  (%BC): 72.8] [Observation (%BC): 72.8] [Emergency Department (%BC): 72.8] [Occupational Therapy (%BC): 72.8] [Physical Therapy (%BC): 72.8] [Respiratory Services/Therapy  (%BC): 72.8] [Speech Therapy (%BC): 72.8] [All Other OP (%BC): 72.8]","count":"1 through 10","median_amount":1263.8,"10th_percentile":1263.8,"90th_percentile":1263.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70.85] [OP Surgery  (%BC): 70.85] [Observation (%BC): 70.85] [Emergency Department (%BC): 70.85] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85]","count":"586","median_amount":728.75,"10th_percentile":314.09,"90th_percentile":1985.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"145","median_amount":163.44,"10th_percentile":72.64,"90th_percentile":295.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"17","median_amount":826.6,"10th_percentile":361.15,"90th_percentile":2132.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 71.54 Maximum Reimbursement 48190] [Cardiac Cath (%BC): 71.54 Maximum Reimbursement 54213] [Observation (%BC): 71.54 Maximum Reimbursement 15662] [Emergency Department (%BC): 71.54 Maximum Reimbursement 15662] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85 Charge Threshold 60000 (%BC): 70.85]","count":"19","median_amount":620.78,"10th_percentile":389.68,"90th_percentile":3017.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"141","median_amount":760.32,"10th_percentile":424.2,"90th_percentile":2247.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"29","median_amount":646.56,"10th_percentile":452.4,"90th_percentile":1408.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"406","median_amount":111.07,"10th_percentile":71.1,"90th_percentile":298.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"33","median_amount":193.84,"10th_percentile":74.05,"90th_percentile":273.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [APC ($): FEE SCHEDULE]","count":"14","median_amount":90.32,"10th_percentile":72.64,"90th_percentile":181.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"114","median_amount":144.14,"10th_percentile":69.74,"90th_percentile":288.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":1105.72,"10th_percentile":1105.72,"90th_percentile":1105.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"95","median_amount":620.02,"10th_percentile":442.68,"90th_percentile":2496.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"308","median_amount":89.96,"10th_percentile":70.25,"90th_percentile":198.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"25","median_amount":105.18,"10th_percentile":85.34,"90th_percentile":325.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Imaging without Contrast","code_information":[{"code":"5522","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"276","median_amount":138.03,"10th_percentile":88.72,"90th_percentile":304.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Coventry/Non Gatekeeper Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72.8] [OP Surgery  (%BC): 72.8] [Observation (%BC): 72.8] [Emergency Department (%BC): 72.8] [Occupational Therapy (%BC): 72.8] [Physical Therapy (%BC): 72.8] [Respiratory Services/Therapy  (%BC): 72.8] [Speech Therapy (%BC): 72.8] [All Other OP (%BC): 72.8]","count":"11","median_amount":964.3,"10th_percentile":496.9,"90th_percentile":3227.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70.85] [OP Surgery  (%BC): 70.85] [Observation (%BC): 70.85] [Emergency Department (%BC): 70.85] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85]","count":"783","median_amount":1186.13,"10th_percentile":336.54,"90th_percentile":2451.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"188","median_amount":138.03,"10th_percentile":72.64,"90th_percentile":319.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"27","median_amount":1701.4,"10th_percentile":361.0,"90th_percentile":2837.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 71.54 Maximum Reimbursement 48190] [Cardiac Cath (%BC): 71.54 Maximum Reimbursement 54213] [Observation (%BC): 71.54 Maximum Reimbursement 15662] [Emergency Department (%BC): 71.54 Maximum Reimbursement 15662] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85 Charge Threshold 60000 (%BC): 70.85]","count":"39","median_amount":1054.95,"10th_percentile":342.35,"90th_percentile":2271.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"222","median_amount":1195.54,"10th_percentile":480.05,"90th_percentile":2433.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"48","median_amount":1291.84,"10th_percentile":397.49,"90th_percentile":3577.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"450","median_amount":140.71,"10th_percentile":74.05,"90th_percentile":284.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"12","median_amount":140.71,"10th_percentile":74.05,"90th_percentile":366.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [APC ($): FEE SCHEDULE]","count":"27","median_amount":108.63,"10th_percentile":86.91,"90th_percentile":193.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"210","median_amount":138.03,"10th_percentile":97.92,"90th_percentile":255.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":1099.58,"10th_percentile":1099.58,"90th_percentile":1099.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"124","median_amount":1254.6,"10th_percentile":395.4,"90th_percentile":2654.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"608","median_amount":112.98,"10th_percentile":91.25,"90th_percentile":218.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"134","median_amount":110.85,"10th_percentile":103.25,"90th_percentile":110.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Imaging without Contrast","code_information":[{"code":"5523","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"93","median_amount":312.1,"10th_percentile":217.81,"90th_percentile":404.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Coventry/Non Gatekeeper Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72.8] [OP Surgery  (%BC): 72.8] [Observation (%BC): 72.8] [Emergency Department (%BC): 72.8] [Occupational Therapy (%BC): 72.8] [Physical Therapy (%BC): 72.8] [Respiratory Services/Therapy  (%BC): 72.8] [Speech Therapy (%BC): 72.8] [All Other OP (%BC): 72.8]","count":"1 through 10","median_amount":3777.4,"10th_percentile":3283.3,"90th_percentile":4141.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70.85] [OP Surgery  (%BC): 70.85] [Observation (%BC): 70.85] [Emergency Department (%BC): 70.85] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85]","count":"258","median_amount":3546.85,"10th_percentile":1592.25,"90th_percentile":5038.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"71","median_amount":312.1,"10th_percentile":295.13,"90th_percentile":363.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"1 through 10","median_amount":3501.08,"10th_percentile":791.14,"90th_percentile":4534.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 71.54 Maximum Reimbursement 48190] [Cardiac Cath (%BC): 71.54 Maximum Reimbursement 54213] [Observation (%BC): 71.54 Maximum Reimbursement 15662] [Emergency Department (%BC): 71.54 Maximum Reimbursement 15662] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85 Charge Threshold 60000 (%BC): 70.85]","count":"1 through 10","median_amount":2361.22,"10th_percentile":950.81,"90th_percentile":4850.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"85","median_amount":3591.56,"10th_percentile":3146.4,"90th_percentile":6593.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":3885.96,"10th_percentile":2570.04,"90th_percentile":6547.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"151","median_amount":318.16,"10th_percentile":300.86,"90th_percentile":412.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":318.16,"10th_percentile":318.16,"90th_percentile":318.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":247.94,"10th_percentile":213.78,"90th_percentile":330.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"65","median_amount":312.1,"10th_percentile":291.96,"90th_percentile":385.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"24","median_amount":4046.85,"10th_percentile":812.5,"90th_percentile":5676.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"214","median_amount":241.21,"10th_percentile":139.21,"90th_percentile":371.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"53","median_amount":251.97,"10th_percentile":251.97,"90th_percentile":563.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 4 Imaging without Contrast","code_information":[{"code":"5524","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"40","median_amount":560.1,"10th_percentile":537.74,"90th_percentile":774.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Coventry/Non Gatekeeper Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72.8] [OP Surgery  (%BC): 72.8] [Observation (%BC): 72.8] [Emergency Department (%BC): 72.8] [Occupational Therapy (%BC): 72.8] [Physical Therapy (%BC): 72.8] [Respiratory Services/Therapy  (%BC): 72.8] [Speech Therapy (%BC): 72.8] [All Other OP (%BC): 72.8]","count":"1 through 10","median_amount":2769.06,"10th_percentile":2769.06,"90th_percentile":2769.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70.85] [OP Surgery  (%BC): 70.85] [Observation (%BC): 70.85] [Emergency Department (%BC): 70.85] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85]","count":"89","median_amount":3392.3,"10th_percentile":2544.65,"90th_percentile":5923.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"32","median_amount":560.1,"10th_percentile":537.74,"90th_percentile":773.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"1 through 10","median_amount":3032.4,"10th_percentile":1005.31,"90th_percentile":3638.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 71.54 Maximum Reimbursement 48190] [Cardiac Cath (%BC): 71.54 Maximum Reimbursement 54213] [Observation (%BC): 71.54 Maximum Reimbursement 15662] [Emergency Department (%BC): 71.54 Maximum Reimbursement 15662] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85 Charge Threshold 60000 (%BC): 70.85]","count":"1 through 10","median_amount":3392.3,"10th_percentile":3392.3,"90th_percentile":3392.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"21","median_amount":3385.12,"10th_percentile":3385.12,"90th_percentile":5360.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":4896.62,"10th_percentile":4896.62,"90th_percentile":4896.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"64","median_amount":570.98,"10th_percentile":548.18,"90th_percentile":763.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":789.53,"10th_percentile":789.53,"90th_percentile":789.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":560.1,"10th_percentile":537.74,"90th_percentile":636.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"13","median_amount":560.1,"10th_percentile":560.1,"90th_percentile":639.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"11","median_amount":3845.61,"10th_percentile":2713.2,"90th_percentile":5299.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"90","median_amount":543.79,"10th_percentile":464.94,"90th_percentile":737.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"12","median_amount":571.56,"10th_percentile":571.56,"90th_percentile":682.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Imaging with Contrast","code_information":[{"code":"5571","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"41","median_amount":398.86,"10th_percentile":377.16,"90th_percentile":971.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Coventry/Non Gatekeeper Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72.8] [OP Surgery  (%BC): 72.8] [Observation (%BC): 72.8] [Emergency Department (%BC): 72.8] [Occupational Therapy (%BC): 72.8] [Physical Therapy (%BC): 72.8] [Respiratory Services/Therapy  (%BC): 72.8] [Speech Therapy (%BC): 72.8] [All Other OP (%BC): 72.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70.85] [OP Surgery  (%BC): 70.85] [Observation (%BC): 70.85] [Emergency Department (%BC): 70.85] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85]","count":"131","median_amount":5021.22,"10th_percentile":2511.13,"90th_percentile":9706.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"28","median_amount":393.19,"10th_percentile":371.8,"90th_percentile":848.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"1 through 10","median_amount":4181.52,"10th_percentile":927.96,"90th_percentile":9223.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 71.54 Maximum Reimbursement 48190] [Cardiac Cath (%BC): 71.54 Maximum Reimbursement 54213] [Observation (%BC): 71.54 Maximum Reimbursement 15662] [Emergency Department (%BC): 71.54 Maximum Reimbursement 15662] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85 Charge Threshold 60000 (%BC): 70.85]","count":"1 through 10","median_amount":3593.03,"10th_percentile":3485.25,"90th_percentile":7535.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"35","median_amount":5610.46,"10th_percentile":2703.26,"90th_percentile":7829.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":4703.99,"10th_percentile":2725.08,"90th_percentile":10159.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"88","median_amount":406.61,"10th_percentile":379.02,"90th_percentile":1334.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":183.31,"10th_percentile":182.6,"90th_percentile":1879.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"27","median_amount":461.23,"10th_percentile":371.8,"90th_percentile":1461.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":11616.57,"10th_percentile":11616.57,"90th_percentile":11616.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"21","median_amount":8859.03,"10th_percentile":1060.0,"90th_percentile":12141.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"108","median_amount":360.97,"10th_percentile":152.77,"90th_percentile":1300.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"45","median_amount":421.49,"10th_percentile":172.56,"90th_percentile":453.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Imaging with Contrast","code_information":[{"code":"5572","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"42","median_amount":526.58,"10th_percentile":380.53,"90th_percentile":950.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Coventry/Non Gatekeeper Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72.8] [OP Surgery  (%BC): 72.8] [Observation (%BC): 72.8] [Emergency Department (%BC): 72.8] [Occupational Therapy (%BC): 72.8] [Physical Therapy (%BC): 72.8] [Respiratory Services/Therapy  (%BC): 72.8] [Speech Therapy (%BC): 72.8] [All Other OP (%BC): 72.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70.85] [OP Surgery  (%BC): 70.85] [Observation (%BC): 70.85] [Emergency Department (%BC): 70.85] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85]","count":"229","median_amount":5590.16,"10th_percentile":3929.62,"90th_percentile":10279.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"35","median_amount":526.58,"10th_percentile":393.19,"90th_percentile":1110.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"1 through 10","median_amount":5006.59,"10th_percentile":4513.98,"90th_percentile":6872.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 71.54 Maximum Reimbursement 48190] [Cardiac Cath (%BC): 71.54 Maximum Reimbursement 54213] [Observation (%BC): 71.54 Maximum Reimbursement 15662] [Emergency Department (%BC): 71.54 Maximum Reimbursement 15662] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85 Charge Threshold 60000 (%BC): 70.85]","count":"1 through 10","median_amount":4936.82,"10th_percentile":3406.97,"90th_percentile":5224.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"67","median_amount":5433.74,"10th_percentile":5014.8,"90th_percentile":10492.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"14","median_amount":5610.51,"10th_percentile":4917.12,"90th_percentile":10440.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"98","median_amount":536.8,"10th_percentile":394.16,"90th_percentile":731.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":366.32,"10th_percentile":366.32,"90th_percentile":620.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"30","median_amount":505.55,"10th_percentile":371.8,"90th_percentile":708.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":212.5,"10th_percentile":212.5,"90th_percentile":212.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"36","median_amount":6332.5,"10th_percentile":4635.06,"90th_percentile":10884.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"98","median_amount":369.58,"10th_percentile":203.11,"90th_percentile":638.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"42","median_amount":372.28,"10th_percentile":361.19,"90th_percentile":372.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Imaging with Contrast","code_information":[{"code":"5573","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":560.1,"10th_percentile":560.1,"90th_percentile":560.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Coventry/Non Gatekeeper Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72.8] [OP Surgery  (%BC): 72.8] [Observation (%BC): 72.8] [Emergency Department (%BC): 72.8] [Occupational Therapy (%BC): 72.8] [Physical Therapy (%BC): 72.8] [Respiratory Services/Therapy  (%BC): 72.8] [Speech Therapy (%BC): 72.8] [All Other OP (%BC): 72.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70.85] [OP Surgery  (%BC): 70.85] [Observation (%BC): 70.85] [Emergency Department (%BC): 70.85] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85]","count":"1 through 10","median_amount":5060.21,"10th_percentile":4400.82,"90th_percentile":23942.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":537.74,"10th_percentile":537.74,"90th_percentile":560.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 71.54 Maximum Reimbursement 48190] [Cardiac Cath (%BC): 71.54 Maximum Reimbursement 54213] [Observation (%BC): 71.54 Maximum Reimbursement 15662] [Emergency Department (%BC): 71.54 Maximum Reimbursement 15662] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85 Charge Threshold 60000 (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":5290.29,"10th_percentile":5290.29,"90th_percentile":16109.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"12","median_amount":570.98,"10th_percentile":548.18,"90th_percentile":589.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":645.68,"10th_percentile":645.68,"90th_percentile":645.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":537.74,"10th_percentile":537.74,"90th_percentile":537.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":795.28,"10th_percentile":619.04,"90th_percentile":871.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":973.89,"10th_percentile":973.89,"90th_percentile":973.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Nuclear Medicine and Related Services","code_information":[{"code":"5591","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":671.9,"10th_percentile":671.9,"90th_percentile":693.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Coventry/Non Gatekeeper Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72.8] [OP Surgery  (%BC): 72.8] [Observation (%BC): 72.8] [Emergency Department (%BC): 72.8] [Occupational Therapy (%BC): 72.8] [Physical Therapy (%BC): 72.8] [Respiratory Services/Therapy  (%BC): 72.8] [Speech Therapy (%BC): 72.8] [All Other OP (%BC): 72.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70.85] [OP Surgery  (%BC): 70.85] [Observation (%BC): 70.85] [Emergency Department (%BC): 70.85] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85]","count":"17","median_amount":2883.57,"10th_percentile":2287.75,"90th_percentile":3658.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":475.3,"10th_percentile":475.3,"90th_percentile":475.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 71.54 Maximum Reimbursement 48190] [Cardiac Cath (%BC): 71.54 Maximum Reimbursement 54213] [Observation (%BC): 71.54 Maximum Reimbursement 15662] [Emergency Department (%BC): 71.54 Maximum Reimbursement 15662] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85 Charge Threshold 60000 (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":3731.67,"10th_percentile":3731.67,"90th_percentile":3731.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":465.18,"10th_percentile":458.18,"90th_percentile":628.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":412.18,"10th_percentile":412.18,"90th_percentile":412.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":489.51,"10th_percentile":489.51,"90th_percentile":489.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":396.35,"10th_percentile":318.88,"90th_percentile":428.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":418.88,"10th_percentile":418.88,"90th_percentile":418.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Nuclear Medicine and Related Services","code_information":[{"code":"5592","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":592.05,"10th_percentile":568.02,"90th_percentile":773.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Coventry/Non Gatekeeper Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72.8] [OP Surgery  (%BC): 72.8] [Observation (%BC): 72.8] [Emergency Department (%BC): 72.8] [Occupational Therapy (%BC): 72.8] [Physical Therapy (%BC): 72.8] [Respiratory Services/Therapy  (%BC): 72.8] [Speech Therapy (%BC): 72.8] [All Other OP (%BC): 72.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70.85] [OP Surgery  (%BC): 70.85] [Observation (%BC): 70.85] [Emergency Department (%BC): 70.85] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85]","count":"22","median_amount":4017.81,"10th_percentile":3582.78,"90th_percentile":5137.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":600.69,"10th_percentile":568.02,"90th_percentile":773.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"1 through 10","median_amount":3663.49,"10th_percentile":3663.49,"90th_percentile":3663.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 71.54 Maximum Reimbursement 48190] [Cardiac Cath (%BC): 71.54 Maximum Reimbursement 54213] [Observation (%BC): 71.54 Maximum Reimbursement 15662] [Emergency Department (%BC): 71.54 Maximum Reimbursement 15662] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85 Charge Threshold 60000 (%BC): 70.85]","count":"1 through 10","median_amount":4017.84,"10th_percentile":4017.84,"90th_percentile":4017.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":3650.73,"10th_percentile":3650.73,"90th_percentile":4009.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":4002.41,"10th_percentile":4002.41,"90th_percentile":4002.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":612.36,"10th_percentile":587.9,"90th_percentile":1167.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":579.06,"10th_percentile":579.06,"90th_percentile":579.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":600.69,"10th_percentile":576.71,"90th_percentile":600.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"1 through 10","median_amount":4820.27,"10th_percentile":4339.59,"90th_percentile":4820.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":574.12,"10th_percentile":574.12,"90th_percentile":574.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":561.1,"10th_percentile":561.1,"90th_percentile":561.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Nuclear Medicine and Related Services","code_information":[{"code":"5593","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"21","median_amount":1567.66,"10th_percentile":1298.79,"90th_percentile":1632.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Coventry/Non Gatekeeper Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72.8] [OP Surgery  (%BC): 72.8] [Observation (%BC): 72.8] [Emergency Department (%BC): 72.8] [Occupational Therapy (%BC): 72.8] [Physical Therapy (%BC): 72.8] [Respiratory Services/Therapy  (%BC): 72.8] [Speech Therapy (%BC): 72.8] [All Other OP (%BC): 72.8]","count":"1 through 10","median_amount":12872.89,"10th_percentile":12872.89,"90th_percentile":12872.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70.85] [OP Surgery  (%BC): 70.85] [Observation (%BC): 70.85] [Emergency Department (%BC): 70.85] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85]","count":"45","median_amount":12340.36,"10th_percentile":8524.36,"90th_percentile":14736.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"16","median_amount":1544.03,"10th_percentile":1319.43,"90th_percentile":1632.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"1 through 10","median_amount":8632.76,"10th_percentile":6906.21,"90th_percentile":12885.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 71.54 Maximum Reimbursement 48190] [Cardiac Cath (%BC): 71.54 Maximum Reimbursement 54213] [Observation (%BC): 71.54 Maximum Reimbursement 15662] [Emergency Department (%BC): 71.54 Maximum Reimbursement 15662] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85 Charge Threshold 60000 (%BC): 70.85]","count":"1 through 10","median_amount":6831.14,"10th_percentile":6831.14,"90th_percentile":6831.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":9979.24,"10th_percentile":9979.24,"90th_percentile":12793.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":12498.34,"10th_percentile":12352.38,"90th_percentile":14085.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"39","median_amount":1379.07,"10th_percentile":513.71,"90th_percentile":1664.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1870.58,"10th_percentile":1870.58,"90th_percentile":1870.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"21","median_amount":1567.66,"10th_percentile":1279.21,"90th_percentile":1632.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"1 through 10","median_amount":11310.95,"10th_percentile":10961.6,"90th_percentile":18902.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"50","median_amount":1590.77,"10th_percentile":1269.39,"90th_percentile":1890.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1360.86,"10th_percentile":1333.61,"90th_percentile":1932.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 4 Nuclear Medicine and Related Services","code_information":[{"code":"5594","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"11","median_amount":1656.85,"10th_percentile":1631.87,"90th_percentile":1725.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Coventry/Non Gatekeeper Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72.8] [OP Surgery  (%BC): 72.8] [Observation (%BC): 72.8] [Emergency Department (%BC): 72.8] [Occupational Therapy (%BC): 72.8] [Physical Therapy (%BC): 72.8] [Respiratory Services/Therapy  (%BC): 72.8] [Speech Therapy (%BC): 72.8] [All Other OP (%BC): 72.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70.85] [OP Surgery  (%BC): 70.85] [Observation (%BC): 70.85] [Emergency Department (%BC): 70.85] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85]","count":"42","median_amount":6913.75,"10th_percentile":6552.54,"90th_percentile":7643.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1725.73,"10th_percentile":1656.85,"90th_percentile":1725.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"1 through 10","median_amount":5719.76,"10th_percentile":5719.76,"90th_percentile":5719.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 71.54 Maximum Reimbursement 48190] [Cardiac Cath (%BC): 71.54 Maximum Reimbursement 54213] [Observation (%BC): 71.54 Maximum Reimbursement 15662] [Emergency Department (%BC): 71.54 Maximum Reimbursement 15662] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85 Charge Threshold 60000 (%BC): 70.85]","count":"1 through 10","median_amount":4564.8,"10th_percentile":4564.8,"90th_percentile":6805.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":6786.24,"10th_percentile":6786.24,"90th_percentile":6786.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":7347.83,"10th_percentile":7347.83,"90th_percentile":7347.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1689.02,"10th_percentile":1689.02,"90th_percentile":1759.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1520.46,"10th_percentile":1520.46,"90th_percentile":1520.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1725.73,"10th_percentile":1656.85,"90th_percentile":1725.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"1 through 10","median_amount":8164.25,"10th_percentile":8164.25,"90th_percentile":10968.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"33","median_amount":1503.4,"10th_percentile":1353.66,"90th_percentile":1556.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"29","median_amount":1520.46,"10th_percentile":1469.31,"90th_percentile":1520.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Therapeutic Radiation Treatment Preparation","code_information":[{"code":"5612","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Coventry/Non Gatekeeper Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72.8] [OP Surgery  (%BC): 72.8] [Observation (%BC): 72.8] [Emergency Department (%BC): 72.8] [Occupational Therapy (%BC): 72.8] [Physical Therapy (%BC): 72.8] [Respiratory Services/Therapy  (%BC): 72.8] [Speech Therapy (%BC): 72.8] [All Other OP (%BC): 72.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70.85] [OP Surgery  (%BC): 70.85] [Observation (%BC): 70.85] [Emergency Department (%BC): 70.85] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 71.54 Maximum Reimbursement 48190] [Cardiac Cath (%BC): 71.54 Maximum Reimbursement 54213] [Observation (%BC): 71.54 Maximum Reimbursement 15662] [Emergency Department (%BC): 71.54 Maximum Reimbursement 15662] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85 Charge Threshold 60000 (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":434.07,"10th_percentile":434.07,"90th_percentile":434.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Therapeutic Radiation Treatment Preparation","code_information":[{"code":"5613","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Coventry/Non Gatekeeper Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72.8] [OP Surgery  (%BC): 72.8] [Observation (%BC): 72.8] [Emergency Department (%BC): 72.8] [Occupational Therapy (%BC): 72.8] [Physical Therapy (%BC): 72.8] [Respiratory Services/Therapy  (%BC): 72.8] [Speech Therapy (%BC): 72.8] [All Other OP (%BC): 72.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70.85] [OP Surgery  (%BC): 70.85] [Observation (%BC): 70.85] [Emergency Department (%BC): 70.85] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85]","count":"1 through 10","median_amount":16976.25,"10th_percentile":16976.25,"90th_percentile":16976.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 71.54 Maximum Reimbursement 48190] [Cardiac Cath (%BC): 71.54 Maximum Reimbursement 54213] [Observation (%BC): 71.54 Maximum Reimbursement 15662] [Emergency Department (%BC): 71.54 Maximum Reimbursement 15662] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85 Charge Threshold 60000 (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":4085.88,"10th_percentile":4085.88,"90th_percentile":4085.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3185.43,"10th_percentile":3185.43,"90th_percentile":3185.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Radiation Therapy","code_information":[{"code":"5622","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Coventry/Non Gatekeeper Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72.8] [OP Surgery  (%BC): 72.8] [Observation (%BC): 72.8] [Emergency Department (%BC): 72.8] [Occupational Therapy (%BC): 72.8] [Physical Therapy (%BC): 72.8] [Respiratory Services/Therapy  (%BC): 72.8] [Speech Therapy (%BC): 72.8] [All Other OP (%BC): 72.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70.85] [OP Surgery  (%BC): 70.85] [Observation (%BC): 70.85] [Emergency Department (%BC): 70.85] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85]","count":"1 through 10","median_amount":28712.25,"10th_percentile":15774.0,"90th_percentile":36174.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"1 through 10","median_amount":23976.48,"10th_percentile":23976.48,"90th_percentile":23976.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 71.54 Maximum Reimbursement 48190] [Cardiac Cath (%BC): 71.54 Maximum Reimbursement 54213] [Observation (%BC): 71.54 Maximum Reimbursement 15662] [Emergency Department (%BC): 71.54 Maximum Reimbursement 15662] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85 Charge Threshold 60000 (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":4005.05,"10th_percentile":4005.05,"90th_percentile":4005.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5557.72,"10th_percentile":5557.72,"90th_percentile":5557.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Radiation Therapy","code_information":[{"code":"5623","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Coventry/Non Gatekeeper Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72.8] [OP Surgery  (%BC): 72.8] [Observation (%BC): 72.8] [Emergency Department (%BC): 72.8] [Occupational Therapy (%BC): 72.8] [Physical Therapy (%BC): 72.8] [Respiratory Services/Therapy  (%BC): 72.8] [Speech Therapy (%BC): 72.8] [All Other OP (%BC): 72.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70.85] [OP Surgery  (%BC): 70.85] [Observation (%BC): 70.85] [Emergency Department (%BC): 70.85] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85]","count":"1 through 10","median_amount":39801.75,"10th_percentile":39801.75,"90th_percentile":55253.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 71.54 Maximum Reimbursement 48190] [Cardiac Cath (%BC): 71.54 Maximum Reimbursement 54213] [Observation (%BC): 71.54 Maximum Reimbursement 15662] [Emergency Department (%BC): 71.54 Maximum Reimbursement 15662] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85 Charge Threshold 60000 (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":3919.33,"10th_percentile":3919.33,"90th_percentile":3919.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"1 through 10","median_amount":61980.3,"10th_percentile":61980.3,"90th_percentile":69542.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Pathology","code_information":[{"code":"5671","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":41.7,"10th_percentile":41.47,"90th_percentile":55.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Coventry/Non Gatekeeper Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72.8] [OP Surgery  (%BC): 72.8] [Observation (%BC): 72.8] [Emergency Department (%BC): 72.8] [Occupational Therapy (%BC): 72.8] [Physical Therapy (%BC): 72.8] [Respiratory Services/Therapy  (%BC): 72.8] [Speech Therapy (%BC): 72.8] [All Other OP (%BC): 72.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70.85] [OP Surgery  (%BC): 70.85] [Observation (%BC): 70.85] [Emergency Department (%BC): 70.85] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85]","count":"13","median_amount":583.1,"10th_percentile":534.78,"90th_percentile":724.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":43.19,"10th_percentile":41.7,"90th_percentile":104.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"1 through 10","median_amount":593.56,"10th_percentile":593.56,"90th_percentile":593.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 71.54 Maximum Reimbursement 48190] [Cardiac Cath (%BC): 71.54 Maximum Reimbursement 54213] [Observation (%BC): 71.54 Maximum Reimbursement 15662] [Emergency Department (%BC): 71.54 Maximum Reimbursement 15662] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85 Charge Threshold 60000 (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":564.89,"10th_percentile":564.89,"90th_percentile":941.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":42.51,"10th_percentile":42.51,"90th_percentile":44.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":80.08,"10th_percentile":80.08,"90th_percentile":80.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"1 through 10","median_amount":696.9,"10th_percentile":696.9,"90th_percentile":696.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":56.78,"10th_percentile":56.78,"90th_percentile":56.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Pathology","code_information":[{"code":"5672","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Coventry/Non Gatekeeper Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72.8] [OP Surgery  (%BC): 72.8] [Observation (%BC): 72.8] [Emergency Department (%BC): 72.8] [Occupational Therapy (%BC): 72.8] [Physical Therapy (%BC): 72.8] [Respiratory Services/Therapy  (%BC): 72.8] [Speech Therapy (%BC): 72.8] [All Other OP (%BC): 72.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70.85] [OP Surgery  (%BC): 70.85] [Observation (%BC): 70.85] [Emergency Department (%BC): 70.85] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85]","count":"1 through 10","median_amount":665.99,"10th_percentile":665.99,"90th_percentile":665.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 71.54 Maximum Reimbursement 48190] [Cardiac Cath (%BC): 71.54 Maximum Reimbursement 54213] [Observation (%BC): 71.54 Maximum Reimbursement 15662] [Emergency Department (%BC): 71.54 Maximum Reimbursement 15662] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85 Charge Threshold 60000 (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":648.31,"10th_percentile":648.31,"90th_percentile":648.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":187.69,"10th_percentile":187.69,"90th_percentile":187.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"1 through 10","median_amount":2126.7,"10th_percentile":2126.7,"90th_percentile":2126.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":182.07,"10th_percentile":182.07,"90th_percentile":182.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Pathology","code_information":[{"code":"5673","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":280.81,"10th_percentile":280.81,"90th_percentile":280.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Coventry/Non Gatekeeper Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72.8] [OP Surgery  (%BC): 72.8] [Observation (%BC): 72.8] [Emergency Department (%BC): 72.8] [Occupational Therapy (%BC): 72.8] [Physical Therapy (%BC): 72.8] [Respiratory Services/Therapy  (%BC): 72.8] [Speech Therapy (%BC): 72.8] [All Other OP (%BC): 72.8]","count":"1 through 10","median_amount":839.68,"10th_percentile":839.68,"90th_percentile":839.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70.85] [OP Surgery  (%BC): 70.85] [Observation (%BC): 70.85] [Emergency Department (%BC): 70.85] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85]","count":"1 through 10","median_amount":1865.48,"10th_percentile":1238.46,"90th_percentile":40061.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":285.11,"10th_percentile":285.11,"90th_percentile":285.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 71.54 Maximum Reimbursement 48190] [Cardiac Cath (%BC): 71.54 Maximum Reimbursement 54213] [Observation (%BC): 71.54 Maximum Reimbursement 15662] [Emergency Department (%BC): 71.54 Maximum Reimbursement 15662] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85 Charge Threshold 60000 (%BC): 70.85]","count":"1 through 10","median_amount":883.5,"10th_percentile":883.5,"90th_percentile":883.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":2931.23,"10th_percentile":2355.02,"90th_percentile":8332.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":314.15,"10th_percentile":260.21,"90th_percentile":410.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":173.47,"10th_percentile":173.47,"90th_percentile":173.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":402.91,"10th_percentile":402.91,"90th_percentile":402.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":382.19,"10th_percentile":367.49,"90th_percentile":1460.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Pathology","code_information":[{"code":"5674","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Coventry/Non Gatekeeper Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72.8] [OP Surgery  (%BC): 72.8] [Observation (%BC): 72.8] [Emergency Department (%BC): 72.8] [Occupational Therapy (%BC): 72.8] [Physical Therapy (%BC): 72.8] [Respiratory Services/Therapy  (%BC): 72.8] [Speech Therapy (%BC): 72.8] [All Other OP (%BC): 72.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70.85] [OP Surgery  (%BC): 70.85] [Observation (%BC): 70.85] [Emergency Department (%BC): 70.85] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85]","count":"1 through 10","median_amount":1802.25,"10th_percentile":1802.25,"90th_percentile":3660.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 71.54 Maximum Reimbursement 48190] [Cardiac Cath (%BC): 71.54 Maximum Reimbursement 54213] [Observation (%BC): 71.54 Maximum Reimbursement 15662] [Emergency Department (%BC): 71.54 Maximum Reimbursement 15662] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85 Charge Threshold 60000 (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":425.44,"10th_percentile":425.44,"90th_percentile":425.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Drug Administration","code_information":[{"code":"5691","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1475.54,"10th_percentile":1475.54,"90th_percentile":1475.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Coventry/Non Gatekeeper Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72.8] [OP Surgery  (%BC): 72.8] [Observation (%BC): 72.8] [Emergency Department (%BC): 72.8] [Occupational Therapy (%BC): 72.8] [Physical Therapy (%BC): 72.8] [Respiratory Services/Therapy  (%BC): 72.8] [Speech Therapy (%BC): 72.8] [All Other OP (%BC): 72.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70.85] [OP Surgery  (%BC): 70.85] [Observation (%BC): 70.85] [Emergency Department (%BC): 70.85] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85]","count":"1 through 10","median_amount":34775.56,"10th_percentile":34775.56,"90th_percentile":34775.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1560.49,"10th_percentile":1560.49,"90th_percentile":1560.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 71.54 Maximum Reimbursement 48190] [Cardiac Cath (%BC): 71.54 Maximum Reimbursement 54213] [Observation (%BC): 71.54 Maximum Reimbursement 15662] [Emergency Department (%BC): 71.54 Maximum Reimbursement 15662] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85 Charge Threshold 60000 (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1183.86,"10th_percentile":1183.86,"90th_percentile":1564.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"1 through 10","median_amount":34289.67,"10th_percentile":34289.67,"90th_percentile":34289.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1903.47,"10th_percentile":1405.97,"90th_percentile":3540.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1300.2,"10th_percentile":1300.2,"90th_percentile":1300.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Drug Administration","code_information":[{"code":"5692","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":247.63,"10th_percentile":247.63,"90th_percentile":260.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Coventry/Non Gatekeeper Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72.8] [OP Surgery  (%BC): 72.8] [Observation (%BC): 72.8] [Emergency Department (%BC): 72.8] [Occupational Therapy (%BC): 72.8] [Physical Therapy (%BC): 72.8] [Respiratory Services/Therapy  (%BC): 72.8] [Speech Therapy (%BC): 72.8] [All Other OP (%BC): 72.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70.85] [OP Surgery  (%BC): 70.85] [Observation (%BC): 70.85] [Emergency Department (%BC): 70.85] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85]","count":"1 through 10","median_amount":1286.85,"10th_percentile":1070.93,"90th_percentile":3964.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 71.54 Maximum Reimbursement 48190] [Cardiac Cath (%BC): 71.54 Maximum Reimbursement 54213] [Observation (%BC): 71.54 Maximum Reimbursement 15662] [Emergency Department (%BC): 71.54 Maximum Reimbursement 15662] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85 Charge Threshold 60000 (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":1516.59,"10th_percentile":1516.59,"90th_percentile":1516.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":1555.37,"10th_percentile":1555.37,"90th_percentile":1555.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"14","median_amount":336.14,"10th_percentile":239.51,"90th_percentile":2078.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":159.8,"10th_percentile":159.8,"90th_percentile":159.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":247.63,"10th_percentile":247.63,"90th_percentile":247.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"1 through 10","median_amount":1690.21,"10th_percentile":1690.21,"90th_percentile":1690.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":240.42,"10th_percentile":171.69,"90th_percentile":275.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":443.88,"10th_percentile":443.88,"90th_percentile":443.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Drug Administration","code_information":[{"code":"5693","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"28","median_amount":661.12,"10th_percentile":222.0,"90th_percentile":915.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Coventry/Non Gatekeeper Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72.8] [OP Surgery  (%BC): 72.8] [Observation (%BC): 72.8] [Emergency Department (%BC): 72.8] [Occupational Therapy (%BC): 72.8] [Physical Therapy (%BC): 72.8] [Respiratory Services/Therapy  (%BC): 72.8] [Speech Therapy (%BC): 72.8] [All Other OP (%BC): 72.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70.85] [OP Surgery  (%BC): 70.85] [Observation (%BC): 70.85] [Emergency Department (%BC): 70.85] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85]","count":"36","median_amount":4378.03,"10th_percentile":2559.17,"90th_percentile":12257.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"16","median_amount":771.22,"10th_percentile":307.4,"90th_percentile":1384.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"1 through 10","median_amount":5534.98,"10th_percentile":5534.98,"90th_percentile":5534.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 71.54 Maximum Reimbursement 48190] [Cardiac Cath (%BC): 71.54 Maximum Reimbursement 54213] [Observation (%BC): 71.54 Maximum Reimbursement 15662] [Emergency Department (%BC): 71.54 Maximum Reimbursement 15662] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85 Charge Threshold 60000 (%BC): 70.85]","count":"1 through 10","median_amount":2967.47,"10th_percentile":2967.47,"90th_percentile":2967.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":4232.53,"10th_percentile":4202.73,"90th_percentile":4503.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":5195.78,"10th_percentile":4437.13,"90th_percentile":12819.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"42","median_amount":784.37,"10th_percentile":252.44,"90th_percentile":1260.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":608.48,"10th_percentile":383.37,"90th_percentile":1236.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1434.24,"10th_percentile":1434.24,"90th_percentile":1434.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"22","median_amount":416.79,"10th_percentile":256.92,"90th_percentile":1554.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"1 through 10","median_amount":5635.04,"10th_percentile":3989.63,"90th_percentile":23326.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"49","median_amount":1043.39,"10th_percentile":636.11,"90th_percentile":1359.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"14","median_amount":1077.13,"10th_percentile":897.93,"90th_percentile":1237.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 4 Drug Administration","code_information":[{"code":"5694","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Coventry/Non Gatekeeper Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72.8] [OP Surgery  (%BC): 72.8] [Observation (%BC): 72.8] [Emergency Department (%BC): 72.8] [Occupational Therapy (%BC): 72.8] [Physical Therapy (%BC): 72.8] [Respiratory Services/Therapy  (%BC): 72.8] [Speech Therapy (%BC): 72.8] [All Other OP (%BC): 72.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70.85] [OP Surgery  (%BC): 70.85] [Observation (%BC): 70.85] [Emergency Department (%BC): 70.85] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 71.54 Maximum Reimbursement 48190] [Cardiac Cath (%BC): 71.54 Maximum Reimbursement 54213] [Observation (%BC): 71.54 Maximum Reimbursement 15662] [Emergency Department (%BC): 71.54 Maximum Reimbursement 15662] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85 Charge Threshold 60000 (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":822.7,"10th_percentile":822.7,"90th_percentile":822.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Diagnostic Tests and Related Services","code_information":[{"code":"5721","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"24","median_amount":196.36,"10th_percentile":185.68,"90th_percentile":196.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Coventry/Non Gatekeeper Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72.8] [OP Surgery  (%BC): 72.8] [Observation (%BC): 72.8] [Emergency Department (%BC): 72.8] [Occupational Therapy (%BC): 72.8] [Physical Therapy (%BC): 72.8] [Respiratory Services/Therapy  (%BC): 72.8] [Speech Therapy (%BC): 72.8] [All Other OP (%BC): 72.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70.85] [OP Surgery  (%BC): 70.85] [Observation (%BC): 70.85] [Emergency Department (%BC): 70.85] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85]","count":"106","median_amount":317.25,"10th_percentile":183.03,"90th_percentile":2461.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":196.36,"10th_percentile":74.5,"90th_percentile":196.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"1 through 10","median_amount":301.64,"10th_percentile":257.18,"90th_percentile":335.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 71.54 Maximum Reimbursement 48190] [Cardiac Cath (%BC): 71.54 Maximum Reimbursement 54213] [Observation (%BC): 71.54 Maximum Reimbursement 15662] [Emergency Department (%BC): 71.54 Maximum Reimbursement 15662] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85 Charge Threshold 60000 (%BC): 70.85]","count":"1 through 10","median_amount":562.48,"10th_percentile":562.48,"90th_percentile":661.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"18","median_amount":311.79,"10th_percentile":304.56,"90th_percentile":395.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":286.76,"10th_percentile":286.76,"90th_percentile":329.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"46","median_amount":200.17,"10th_percentile":189.28,"90th_percentile":343.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":159.84,"10th_percentile":156.58,"90th_percentile":159.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"23","median_amount":196.36,"10th_percentile":185.68,"90th_percentile":4004.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":137.0,"10th_percentile":137.0,"90th_percentile":137.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"19","median_amount":374.85,"10th_percentile":337.36,"90th_percentile":2789.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"15","median_amount":166.88,"10th_percentile":145.71,"90th_percentile":181.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":163.1,"10th_percentile":163.1,"90th_percentile":163.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Diagnostic Tests and Related Services","code_information":[{"code":"5722","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"42","median_amount":282.46,"10th_percentile":231.89,"90th_percentile":450.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Coventry/Non Gatekeeper Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72.8] [OP Surgery  (%BC): 72.8] [Observation (%BC): 72.8] [Emergency Department (%BC): 72.8] [Occupational Therapy (%BC): 72.8] [Physical Therapy (%BC): 72.8] [Respiratory Services/Therapy  (%BC): 72.8] [Speech Therapy (%BC): 72.8] [All Other OP (%BC): 72.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70.85] [OP Surgery  (%BC): 70.85] [Observation (%BC): 70.85] [Emergency Department (%BC): 70.85] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85]","count":"88","median_amount":2012.07,"10th_percentile":785.74,"90th_percentile":3743.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"42","median_amount":274.72,"10th_percentile":243.21,"90th_percentile":428.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"1 through 10","median_amount":1654.9,"10th_percentile":1654.9,"90th_percentile":1864.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 71.54 Maximum Reimbursement 48190] [Cardiac Cath (%BC): 71.54 Maximum Reimbursement 54213] [Observation (%BC): 71.54 Maximum Reimbursement 15662] [Emergency Department (%BC): 71.54 Maximum Reimbursement 15662] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85 Charge Threshold 60000 (%BC): 70.85]","count":"1 through 10","median_amount":1546.12,"10th_percentile":1546.12,"90th_percentile":1546.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"14","median_amount":2442.19,"10th_percentile":2005.27,"90th_percentile":4969.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":1766.68,"10th_percentile":1766.68,"90th_percentile":4669.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"90","median_amount":306.41,"10th_percentile":236.39,"90th_percentile":436.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":419.45,"10th_percentile":419.45,"90th_percentile":419.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":288.89,"10th_percentile":254.5,"90th_percentile":363.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"28","median_amount":319.85,"10th_percentile":245.22,"90th_percentile":428.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"18","median_amount":2592.76,"10th_percentile":1850.62,"90th_percentile":6254.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"92","median_amount":301.63,"10th_percentile":267.22,"90th_percentile":424.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":324.61,"10th_percentile":324.61,"90th_percentile":435.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Diagnostic Tests and Related Services","code_information":[{"code":"5723","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"11","median_amount":257.2,"10th_percentile":243.21,"90th_percentile":366.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Coventry/Non Gatekeeper Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72.8] [OP Surgery  (%BC): 72.8] [Observation (%BC): 72.8] [Emergency Department (%BC): 72.8] [Occupational Therapy (%BC): 72.8] [Physical Therapy (%BC): 72.8] [Respiratory Services/Therapy  (%BC): 72.8] [Speech Therapy (%BC): 72.8] [All Other OP (%BC): 72.8]","count":"1 through 10","median_amount":2339.06,"10th_percentile":2339.06,"90th_percentile":2339.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70.85] [OP Surgery  (%BC): 70.85] [Observation (%BC): 70.85] [Emergency Department (%BC): 70.85] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85]","count":"42","median_amount":3123.07,"10th_percentile":1899.11,"90th_percentile":3843.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":257.2,"10th_percentile":257.2,"90th_percentile":6382.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"1 through 10","median_amount":3454.2,"10th_percentile":3454.2,"90th_percentile":3454.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 71.54 Maximum Reimbursement 48190] [Cardiac Cath (%BC): 71.54 Maximum Reimbursement 54213] [Observation (%BC): 71.54 Maximum Reimbursement 15662] [Emergency Department (%BC): 71.54 Maximum Reimbursement 15662] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85 Charge Threshold 60000 (%BC): 70.85]","count":"1 through 10","median_amount":1000.0,"10th_percentile":1000.0,"90th_percentile":1000.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":3272.4,"10th_percentile":3116.46,"90th_percentile":4892.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":3372.12,"10th_percentile":3372.12,"90th_percentile":3372.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"22","median_amount":262.19,"10th_percentile":262.19,"90th_percentile":262.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1116.86,"10th_percentile":1116.86,"90th_percentile":1116.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"11","median_amount":257.2,"10th_percentile":257.2,"90th_percentile":257.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"1 through 10","median_amount":3746.8,"10th_percentile":2857.44,"90th_percentile":4618.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"19","median_amount":514.73,"10th_percentile":414.4,"90th_percentile":564.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"12","median_amount":553.11,"10th_percentile":553.11,"90th_percentile":553.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 4 Diagnostic Tests and Related Services","code_information":[{"code":"5724","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"23","median_amount":1022.4,"10th_percentile":981.59,"90th_percentile":1022.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Coventry/Non Gatekeeper Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72.8] [OP Surgery  (%BC): 72.8] [Observation (%BC): 72.8] [Emergency Department (%BC): 72.8] [Occupational Therapy (%BC): 72.8] [Physical Therapy (%BC): 72.8] [Respiratory Services/Therapy  (%BC): 72.8] [Speech Therapy (%BC): 72.8] [All Other OP (%BC): 72.8]","count":"1 through 10","median_amount":5466.6,"10th_percentile":5466.6,"90th_percentile":5466.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70.85] [OP Surgery  (%BC): 70.85] [Observation (%BC): 70.85] [Emergency Department (%BC): 70.85] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85]","count":"71","median_amount":4805.19,"10th_percentile":4021.87,"90th_percentile":5720.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"16","median_amount":1022.4,"10th_percentile":981.59,"90th_percentile":1022.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"1 through 10","median_amount":4794.84,"10th_percentile":4794.84,"90th_percentile":4794.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 71.54 Maximum Reimbursement 48190] [Cardiac Cath (%BC): 71.54 Maximum Reimbursement 54213] [Observation (%BC): 71.54 Maximum Reimbursement 15662] [Emergency Department (%BC): 71.54 Maximum Reimbursement 15662] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85 Charge Threshold 60000 (%BC): 70.85]","count":"1 through 10","median_amount":5198.4,"10th_percentile":5198.4,"90th_percentile":5198.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"18","median_amount":5184.0,"10th_percentile":4648.53,"90th_percentile":5305.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":5029.88,"10th_percentile":4648.53,"90th_percentile":5740.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"35","median_amount":1042.25,"10th_percentile":985.56,"90th_percentile":1042.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1042.25,"10th_percentile":1042.25,"90th_percentile":1042.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1039.34,"10th_percentile":1018.13,"90th_percentile":1039.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"13","median_amount":981.59,"10th_percentile":981.59,"90th_percentile":1022.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"21","median_amount":5588.75,"10th_percentile":4290.12,"90th_percentile":6378.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"49","median_amount":1031.92,"10th_percentile":873.05,"90th_percentile":1081.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1060.55,"10th_percentile":981.95,"90th_percentile":1221.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Minor Procedures","code_information":[{"code":"5732","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":79.89,"10th_percentile":76.69,"90th_percentile":137.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Coventry/Non Gatekeeper Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72.8] [OP Surgery  (%BC): 72.8] [Observation (%BC): 72.8] [Emergency Department (%BC): 72.8] [Occupational Therapy (%BC): 72.8] [Physical Therapy (%BC): 72.8] [Respiratory Services/Therapy  (%BC): 72.8] [Speech Therapy (%BC): 72.8] [All Other OP (%BC): 72.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70.85] [OP Surgery  (%BC): 70.85] [Observation (%BC): 70.85] [Emergency Department (%BC): 70.85] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85]","count":"1 through 10","median_amount":1144.94,"10th_percentile":409.14,"90th_percentile":2175.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":79.89,"10th_percentile":79.89,"90th_percentile":108.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 71.54 Maximum Reimbursement 48190] [Cardiac Cath (%BC): 71.54 Maximum Reimbursement 54213] [Observation (%BC): 71.54 Maximum Reimbursement 15662] [Emergency Department (%BC): 71.54 Maximum Reimbursement 15662] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85 Charge Threshold 60000 (%BC): 70.85]","count":"1 through 10","median_amount":1144.94,"10th_percentile":1144.94,"90th_percentile":1144.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":1004.4,"10th_percentile":1004.4,"90th_percentile":1004.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":1142.51,"10th_percentile":1142.51,"90th_percentile":1142.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":81.44,"10th_percentile":81.44,"90th_percentile":174.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"1 through 10","median_amount":840.84,"10th_percentile":840.84,"90th_percentile":1266.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":59.12,"10th_percentile":59.12,"90th_percentile":59.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Minor Procedures","code_information":[{"code":"5733","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"21","median_amount":55.59,"10th_percentile":31.93,"90th_percentile":128.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Coventry/Non Gatekeeper Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72.8] [OP Surgery  (%BC): 72.8] [Observation (%BC): 72.8] [Emergency Department (%BC): 72.8] [Occupational Therapy (%BC): 72.8] [Physical Therapy (%BC): 72.8] [Respiratory Services/Therapy  (%BC): 72.8] [Speech Therapy (%BC): 72.8] [All Other OP (%BC): 72.8]","count":"1 through 10","median_amount":619.03,"10th_percentile":619.03,"90th_percentile":619.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70.85] [OP Surgery  (%BC): 70.85] [Observation (%BC): 70.85] [Emergency Department (%BC): 70.85] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85]","count":"116","median_amount":453.97,"10th_percentile":306.5,"90th_percentile":1465.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"18","median_amount":71.99,"10th_percentile":31.93,"90th_percentile":124.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"1 through 10","median_amount":173.28,"10th_percentile":173.28,"90th_percentile":173.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 71.54 Maximum Reimbursement 48190] [Cardiac Cath (%BC): 71.54 Maximum Reimbursement 54213] [Observation (%BC): 71.54 Maximum Reimbursement 15662] [Emergency Department (%BC): 71.54 Maximum Reimbursement 15662] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85 Charge Threshold 60000 (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"27","median_amount":373.3,"10th_percentile":373.3,"90th_percentile":1114.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":403.92,"10th_percentile":403.92,"90th_percentile":1524.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"49","median_amount":55.39,"10th_percentile":32.55,"90th_percentile":124.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":33.89,"10th_percentile":33.89,"90th_percentile":125.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":73.8,"10th_percentile":73.8,"90th_percentile":73.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"17","median_amount":44.41,"10th_percentile":31.93,"90th_percentile":166.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"22","median_amount":448.8,"10th_percentile":359.04,"90th_percentile":718.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"57","median_amount":59.12,"10th_percentile":32.28,"90th_percentile":77.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Minor Procedures","code_information":[{"code":"5734","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"47","median_amount":75.54,"10th_percentile":12.82,"90th_percentile":141.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Coventry/Non Gatekeeper Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72.8] [OP Surgery  (%BC): 72.8] [Observation (%BC): 72.8] [Emergency Department (%BC): 72.8] [Occupational Therapy (%BC): 72.8] [Physical Therapy (%BC): 72.8] [Respiratory Services/Therapy  (%BC): 72.8] [Speech Therapy (%BC): 72.8] [All Other OP (%BC): 72.8]","count":"1 through 10","median_amount":762.73,"10th_percentile":762.73,"90th_percentile":762.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70.85] [OP Surgery  (%BC): 70.85] [Observation (%BC): 70.85] [Emergency Department (%BC): 70.85] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85]","count":"106","median_amount":618.75,"10th_percentile":387.8,"90th_percentile":1592.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"43","median_amount":37.02,"10th_percentile":12.82,"90th_percentile":141.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"1 through 10","median_amount":479.77,"10th_percentile":405.08,"90th_percentile":1685.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 71.54 Maximum Reimbursement 48190] [Cardiac Cath (%BC): 71.54 Maximum Reimbursement 54213] [Observation (%BC): 71.54 Maximum Reimbursement 15662] [Emergency Department (%BC): 71.54 Maximum Reimbursement 15662] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85 Charge Threshold 60000 (%BC): 70.85]","count":"1 through 10","median_amount":584.51,"10th_percentile":584.51,"90th_percentile":584.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"29","median_amount":997.92,"10th_percentile":406.52,"90th_percentile":2006.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":439.88,"10th_percentile":439.88,"90th_percentile":1613.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"81","median_amount":85.4,"10th_percentile":23.09,"90th_percentile":210.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":109.84,"10th_percentile":109.84,"90th_percentile":109.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":118.05,"10th_percentile":118.05,"90th_percentile":131.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"40","median_amount":45.91,"10th_percentile":12.29,"90th_percentile":141.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"18","median_amount":750.42,"10th_percentile":439.88,"90th_percentile":2848.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"66","median_amount":131.69,"10th_percentile":103.87,"90th_percentile":137.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"17","median_amount":134.37,"10th_percentile":134.37,"90th_percentile":134.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Electronic Analysis of Devices","code_information":[{"code":"5741","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":75.48,"10th_percentile":75.48,"90th_percentile":83.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Coventry/Non Gatekeeper Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72.8] [OP Surgery  (%BC): 72.8] [Observation (%BC): 72.8] [Emergency Department (%BC): 72.8] [Occupational Therapy (%BC): 72.8] [Physical Therapy (%BC): 72.8] [Respiratory Services/Therapy  (%BC): 72.8] [Speech Therapy (%BC): 72.8] [All Other OP (%BC): 72.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70.85] [OP Surgery  (%BC): 70.85] [Observation (%BC): 70.85] [Emergency Department (%BC): 70.85] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85]","count":"21","median_amount":948.68,"10th_percentile":808.47,"90th_percentile":1095.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":53.97,"10th_percentile":53.97,"90th_percentile":183.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 71.54 Maximum Reimbursement 48190] [Cardiac Cath (%BC): 71.54 Maximum Reimbursement 54213] [Observation (%BC): 71.54 Maximum Reimbursement 15662] [Emergency Department (%BC): 71.54 Maximum Reimbursement 15662] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85 Charge Threshold 60000 (%BC): 70.85]","count":"1 through 10","median_amount":928.68,"10th_percentile":928.68,"90th_percentile":928.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":946.67,"10th_percentile":832.32,"90th_percentile":3460.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"15","median_amount":55.02,"10th_percentile":52.82,"90th_percentile":152.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"1 through 10","median_amount":2713.2,"10th_percentile":2713.2,"90th_percentile":2713.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":39.62,"10th_percentile":32.0,"90th_percentile":39.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Rehabilitation","code_information":[{"code":"5771","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Coventry/Non Gatekeeper Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72.8] [OP Surgery  (%BC): 72.8] [Observation (%BC): 72.8] [Emergency Department (%BC): 72.8] [Occupational Therapy (%BC): 72.8] [Physical Therapy (%BC): 72.8] [Respiratory Services/Therapy  (%BC): 72.8] [Speech Therapy (%BC): 72.8] [All Other OP (%BC): 72.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70.85] [OP Surgery  (%BC): 70.85] [Observation (%BC): 70.85] [Emergency Department (%BC): 70.85] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85]","count":"16","median_amount":1881.75,"10th_percentile":1293.01,"90th_percentile":3124.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1614.72,"10th_percentile":807.36,"90th_percentile":2825.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 71.54 Maximum Reimbursement 48190] [Cardiac Cath (%BC): 71.54 Maximum Reimbursement 54213] [Observation (%BC): 71.54 Maximum Reimbursement 15662] [Emergency Department (%BC): 71.54 Maximum Reimbursement 15662] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85 Charge Threshold 60000 (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":2946.24,"10th_percentile":2580.6,"90th_percentile":3096.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":2127.84,"10th_percentile":2127.84,"90th_percentile":2127.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1646.08,"10th_percentile":395.1,"90th_percentile":2845.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1816.56,"10th_percentile":1816.56,"90th_percentile":1816.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"1 through 10","median_amount":2028.95,"10th_percentile":1993.95,"90th_percentile":3678.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"26","median_amount":668.85,"10th_percentile":267.54,"90th_percentile":1672.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"16","median_amount":1181.25,"10th_percentile":656.25,"90th_percentile":1575.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Pulmonary Treatment","code_information":[{"code":"5791","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":260.46,"10th_percentile":196.37,"90th_percentile":394.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Coventry/Non Gatekeeper Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72.8] [OP Surgery  (%BC): 72.8] [Observation (%BC): 72.8] [Emergency Department (%BC): 72.8] [Occupational Therapy (%BC): 72.8] [Physical Therapy (%BC): 72.8] [Respiratory Services/Therapy  (%BC): 72.8] [Speech Therapy (%BC): 72.8] [All Other OP (%BC): 72.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70.85] [OP Surgery  (%BC): 70.85] [Observation (%BC): 70.85] [Emergency Department (%BC): 70.85] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85]","count":"1 through 10","median_amount":3850.98,"10th_percentile":3829.23,"90th_percentile":50495.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":214.85,"10th_percentile":193.41,"90th_percentile":391.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 71.54 Maximum Reimbursement 48190] [Cardiac Cath (%BC): 71.54 Maximum Reimbursement 54213] [Observation (%BC): 71.54 Maximum Reimbursement 15662] [Emergency Department (%BC): 71.54 Maximum Reimbursement 15662] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85 Charge Threshold 60000 (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":1356.47,"10th_percentile":1246.47,"90th_percentile":1529.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"18","median_amount":262.73,"10th_percentile":197.17,"90th_percentile":4161.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":200.18,"10th_percentile":200.18,"90th_percentile":200.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":268.44,"10th_percentile":204.54,"90th_percentile":4148.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":288.64,"10th_percentile":288.64,"90th_percentile":288.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"1 through 10","median_amount":50170.39,"10th_percentile":50170.39,"90th_percentile":50170.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":260.62,"10th_percentile":195.6,"90th_percentile":461.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventilation Initiation and Management","code_information":[{"code":"5801","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Coventry/Non Gatekeeper Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72.8] [OP Surgery  (%BC): 72.8] [Observation (%BC): 72.8] [Emergency Department (%BC): 72.8] [Occupational Therapy (%BC): 72.8] [Physical Therapy (%BC): 72.8] [Respiratory Services/Therapy  (%BC): 72.8] [Speech Therapy (%BC): 72.8] [All Other OP (%BC): 72.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70.85] [OP Surgery  (%BC): 70.85] [Observation (%BC): 70.85] [Emergency Department (%BC): 70.85] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 71.54 Maximum Reimbursement 48190] [Cardiac Cath (%BC): 71.54 Maximum Reimbursement 54213] [Observation (%BC): 71.54 Maximum Reimbursement 15662] [Emergency Department (%BC): 71.54 Maximum Reimbursement 15662] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85 Charge Threshold 60000 (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1126.83,"10th_percentile":1126.83,"90th_percentile":1126.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Health and Behavior Services","code_information":[{"code":"5822","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"18","median_amount":435.61,"10th_percentile":167.41,"90th_percentile":2176.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Coventry/Non Gatekeeper Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72.8] [OP Surgery  (%BC): 72.8] [Observation (%BC): 72.8] [Emergency Department (%BC): 72.8] [Occupational Therapy (%BC): 72.8] [Physical Therapy (%BC): 72.8] [Respiratory Services/Therapy  (%BC): 72.8] [Speech Therapy (%BC): 72.8] [All Other OP (%BC): 72.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70.85] [OP Surgery  (%BC): 70.85] [Observation (%BC): 70.85] [Emergency Department (%BC): 70.85] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85]","count":"42","median_amount":726.92,"10th_percentile":225.1,"90th_percentile":4863.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"30","median_amount":698.35,"10th_percentile":316.6,"90th_percentile":2260.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 71.54 Maximum Reimbursement 48190] [Cardiac Cath (%BC): 71.54 Maximum Reimbursement 54213] [Observation (%BC): 71.54 Maximum Reimbursement 15662] [Emergency Department (%BC): 71.54 Maximum Reimbursement 15662] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85 Charge Threshold 60000 (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":1429.38,"10th_percentile":1429.38,"90th_percentile":1429.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"53","median_amount":511.98,"10th_percentile":165.09,"90th_percentile":1158.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"21","median_amount":575.6,"10th_percentile":323.9,"90th_percentile":1506.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"1 through 10","median_amount":2480.09,"10th_percentile":2480.09,"90th_percentile":2480.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":95.27,"10th_percentile":49.23,"90th_percentile":190.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Health and Behavior Services","code_information":[{"code":"5823","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"383","median_amount":109.84,"10th_percentile":103.87,"90th_percentile":276.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Coventry/Non Gatekeeper Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72.8] [OP Surgery  (%BC): 72.8] [Observation (%BC): 72.8] [Emergency Department (%BC): 72.8] [Occupational Therapy (%BC): 72.8] [Physical Therapy (%BC): 72.8] [Respiratory Services/Therapy  (%BC): 72.8] [Speech Therapy (%BC): 72.8] [All Other OP (%BC): 72.8]","count":"1 through 10","median_amount":362.96,"10th_percentile":192.02,"90th_percentile":651.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70.85] [OP Surgery  (%BC): 70.85] [Observation (%BC): 70.85] [Emergency Department (%BC): 70.85] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85]","count":"646","median_amount":315.28,"10th_percentile":111.97,"90th_percentile":662.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"237","median_amount":109.84,"10th_percentile":103.87,"90th_percentile":212.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"35","median_amount":336.0,"10th_percentile":281.0,"90th_percentile":620.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 71.54 Maximum Reimbursement 48190] [Cardiac Cath (%BC): 71.54 Maximum Reimbursement 54213] [Observation (%BC): 71.54 Maximum Reimbursement 15662] [Emergency Department (%BC): 71.54 Maximum Reimbursement 15662] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85 Charge Threshold 60000 (%BC): 70.85]","count":"16","median_amount":343.22,"10th_percentile":275.28,"90th_percentile":667.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"113","median_amount":333.68,"10th_percentile":210.93,"90th_percentile":704.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"36","median_amount":307.53,"10th_percentile":138.29,"90th_percentile":534.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"562","median_amount":111.97,"10th_percentile":105.88,"90th_percentile":223.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"16","median_amount":174.05,"10th_percentile":105.88,"90th_percentile":195.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [APC ($): FEE SCHEDULE]","count":"16","median_amount":164.81,"10th_percentile":162.13,"90th_percentile":167.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"300","median_amount":109.84,"10th_percentile":91.92,"90th_percentile":219.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":112.56,"10th_percentile":56.28,"90th_percentile":234.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"35","median_amount":150.74,"10th_percentile":112.31,"90th_percentile":343.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"55","median_amount":139.65,"10th_percentile":98.49,"90th_percentile":171.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":167.49,"10th_percentile":167.49,"90th_percentile":167.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Inj, acetaminophen (b braun)","code_information":[{"code":"9160","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Coventry/Non Gatekeeper Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72.8] [OP Surgery  (%BC): 72.8] [Observation (%BC): 72.8] [Emergency Department (%BC): 72.8] [Occupational Therapy (%BC): 72.8] [Physical Therapy (%BC): 72.8] [Respiratory Services/Therapy  (%BC): 72.8] [Speech Therapy (%BC): 72.8] [All Other OP (%BC): 72.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70.85] [OP Surgery  (%BC): 70.85] [Observation (%BC): 70.85] [Emergency Department (%BC): 70.85] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 71.54 Maximum Reimbursement 48190] [Cardiac Cath (%BC): 71.54 Maximum Reimbursement 54213] [Observation (%BC): 71.54 Maximum Reimbursement 15662] [Emergency Department (%BC): 71.54 Maximum Reimbursement 15662] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85 Charge Threshold 60000 (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":6179.98,"10th_percentile":6179.98,"90th_percentile":6179.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inj, bupivacaine, nos, 0.5mg","code_information":[{"code":"9290","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":841.76,"10th_percentile":841.76,"90th_percentile":841.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Coventry/Non Gatekeeper Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72.8] [OP Surgery  (%BC): 72.8] [Observation (%BC): 72.8] [Emergency Department (%BC): 72.8] [Occupational Therapy (%BC): 72.8] [Physical Therapy (%BC): 72.8] [Respiratory Services/Therapy  (%BC): 72.8] [Speech Therapy (%BC): 72.8] [All Other OP (%BC): 72.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70.85] [OP Surgery  (%BC): 70.85] [Observation (%BC): 70.85] [Emergency Department (%BC): 70.85] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":561.17,"10th_percentile":561.17,"90th_percentile":561.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 71.54 Maximum Reimbursement 48190] [Cardiac Cath (%BC): 71.54 Maximum Reimbursement 54213] [Observation (%BC): 71.54 Maximum Reimbursement 15662] [Emergency Department (%BC): 71.54 Maximum Reimbursement 15662] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85 Charge Threshold 60000 (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Platelet pheres leukoreduced","code_information":[{"code":"9501","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Coventry/Non Gatekeeper Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72.8] [OP Surgery  (%BC): 72.8] [Observation (%BC): 72.8] [Emergency Department (%BC): 72.8] [Occupational Therapy (%BC): 72.8] [Physical Therapy (%BC): 72.8] [Respiratory Services/Therapy  (%BC): 72.8] [Speech Therapy (%BC): 72.8] [All Other OP (%BC): 72.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70.85] [OP Surgery  (%BC): 70.85] [Observation (%BC): 70.85] [Emergency Department (%BC): 70.85] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 71.54 Maximum Reimbursement 48190] [Cardiac Cath (%BC): 71.54 Maximum Reimbursement 54213] [Observation (%BC): 71.54 Maximum Reimbursement 15662] [Emergency Department (%BC): 71.54 Maximum Reimbursement 15662] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85 Charge Threshold 60000 (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":867.47,"10th_percentile":867.47,"90th_percentile":867.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":844.43,"10th_percentile":844.43,"90th_percentile":844.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"RBC leukocytes reduced","code_information":[{"code":"9512","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Coventry/Non Gatekeeper Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72.8] [OP Surgery  (%BC): 72.8] [Observation (%BC): 72.8] [Emergency Department (%BC): 72.8] [Occupational Therapy (%BC): 72.8] [Physical Therapy (%BC): 72.8] [Respiratory Services/Therapy  (%BC): 72.8] [Speech Therapy (%BC): 72.8] [All Other OP (%BC): 72.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70.85] [OP Surgery  (%BC): 70.85] [Observation (%BC): 70.85] [Emergency Department (%BC): 70.85] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 71.54 Maximum Reimbursement 48190] [Cardiac Cath (%BC): 71.54 Maximum Reimbursement 54213] [Observation (%BC): 71.54 Maximum Reimbursement 15662] [Emergency Department (%BC): 71.54 Maximum Reimbursement 15662] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85 Charge Threshold 60000 (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2701.77,"10th_percentile":2701.77,"90th_percentile":2701.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-OPPS Clinic Services","code_information":[{"code":"N700","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Coventry/Non Gatekeeper Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72.8] [OP Surgery  (%BC): 72.8] [Observation (%BC): 72.8] [Emergency Department (%BC): 72.8] [Occupational Therapy (%BC): 72.8] [Physical Therapy (%BC): 72.8] [Respiratory Services/Therapy  (%BC): 72.8] [Speech Therapy (%BC): 72.8] [All Other OP (%BC): 72.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70.85] [OP Surgery  (%BC): 70.85] [Observation (%BC): 70.85] [Emergency Department (%BC): 70.85] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85]","count":"20","median_amount":187.5,"10th_percentile":150.95,"90th_percentile":423.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 71.54 Maximum Reimbursement 48190] [Cardiac Cath (%BC): 71.54 Maximum Reimbursement 54213] [Observation (%BC): 71.54 Maximum Reimbursement 15662] [Emergency Department (%BC): 71.54 Maximum Reimbursement 15662] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85 Charge Threshold 60000 (%BC): 70.85]","count":"1 through 10","median_amount":177.13,"10th_percentile":177.13,"90th_percentile":562.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":176.75,"10th_percentile":176.75,"90th_percentile":176.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":31.94,"10th_percentile":31.94,"90th_percentile":31.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"1 through 10","median_amount":381.09,"10th_percentile":265.69,"90th_percentile":712.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"21","median_amount":136.92,"10th_percentile":126.54,"90th_percentile":273.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":537.36,"10th_percentile":537.36,"90th_percentile":537.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Clinical Diagnostic Lab Services","code_information":[{"code":"N800","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1130","median_amount":34.41,"10th_percentile":9.48,"90th_percentile":113.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Coventry/Non Gatekeeper Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72.8] [OP Surgery  (%BC): 72.8] [Observation (%BC): 72.8] [Emergency Department (%BC): 72.8] [Occupational Therapy (%BC): 72.8] [Physical Therapy (%BC): 72.8] [Respiratory Services/Therapy  (%BC): 72.8] [Speech Therapy (%BC): 72.8] [All Other OP (%BC): 72.8]","count":"32","median_amount":598.72,"10th_percentile":134.84,"90th_percentile":1281.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70.85] [OP Surgery  (%BC): 70.85] [Observation (%BC): 70.85] [Emergency Department (%BC): 70.85] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85]","count":"2592","median_amount":476.23,"10th_percentile":118.42,"90th_percentile":1466.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"929","median_amount":33.07,"10th_percentile":8.35,"90th_percentile":109.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"91","median_amount":552.52,"10th_percentile":169.48,"90th_percentile":1486.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":143.88,"10th_percentile":143.88,"90th_percentile":143.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 71.54 Maximum Reimbursement 48190] [Cardiac Cath (%BC): 71.54 Maximum Reimbursement 54213] [Observation (%BC): 71.54 Maximum Reimbursement 15662] [Emergency Department (%BC): 71.54 Maximum Reimbursement 15662] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85 Charge Threshold 60000 (%BC): 70.85]","count":"92","median_amount":410.23,"10th_percentile":158.12,"90th_percentile":1049.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"738","median_amount":550.05,"10th_percentile":124.56,"90th_percentile":1741.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"147","median_amount":589.82,"10th_percentile":143.51,"90th_percentile":1364.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"2358","median_amount":31.43,"10th_percentile":9.27,"90th_percentile":112.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"150","median_amount":47.44,"10th_percentile":11.27,"90th_percentile":131.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [APC ($): FEE SCHEDULE]","count":"102","median_amount":39.52,"10th_percentile":11.02,"90th_percentile":157.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"873","median_amount":33.91,"10th_percentile":9.48,"90th_percentile":140.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":712.14,"10th_percentile":165.49,"90th_percentile":831.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":37.38,"10th_percentile":37.38,"90th_percentile":37.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"390","median_amount":533.8,"10th_percentile":156.6,"90th_percentile":1555.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"2468","median_amount":52.03,"10th_percentile":11.18,"90th_percentile":161.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"44","median_amount":41.98,"10th_percentile":13.35,"90th_percentile":119.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Therapy Services","code_information":[{"code":"N801","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"377","median_amount":286.56,"10th_percentile":132.26,"90th_percentile":616.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Coventry/Non Gatekeeper Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72.8] [OP Surgery  (%BC): 72.8] [Observation (%BC): 72.8] [Emergency Department (%BC): 72.8] [Occupational Therapy (%BC): 72.8] [Physical Therapy (%BC): 72.8] [Respiratory Services/Therapy  (%BC): 72.8] [Speech Therapy (%BC): 72.8] [All Other OP (%BC): 72.8]","count":"1 through 10","median_amount":1284.83,"10th_percentile":558.42,"90th_percentile":3867.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70.85] [OP Surgery  (%BC): 70.85] [Observation (%BC): 70.85] [Emergency Department (%BC): 70.85] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85]","count":"1394","median_amount":924.44,"10th_percentile":43.2,"90th_percentile":2583.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"270","median_amount":291.76,"10th_percentile":88.17,"90th_percentile":571.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"55","median_amount":1015.74,"10th_percentile":245.13,"90th_percentile":2526.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":609.04,"10th_percentile":609.04,"90th_percentile":609.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 71.54 Maximum Reimbursement 48190] [Cardiac Cath (%BC): 71.54 Maximum Reimbursement 54213] [Observation (%BC): 71.54 Maximum Reimbursement 15662] [Emergency Department (%BC): 71.54 Maximum Reimbursement 15662] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85 Charge Threshold 60000 (%BC): 70.85]","count":"37","median_amount":535.63,"10th_percentile":143.21,"90th_percentile":2847.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"328","median_amount":1022.35,"10th_percentile":236.8,"90th_percentile":3158.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"87","median_amount":844.74,"10th_percentile":171.88,"90th_percentile":2997.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"871","median_amount":239.91,"10th_percentile":57.6,"90th_percentile":600.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"72","median_amount":249.89,"10th_percentile":71.3,"90th_percentile":852.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [APC ($): FEE SCHEDULE]","count":"46","median_amount":182.14,"10th_percentile":25.54,"90th_percentile":380.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"384","median_amount":214.76,"10th_percentile":57.6,"90th_percentile":572.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":70.0,"10th_percentile":70.0,"90th_percentile":420.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"189","median_amount":841.5,"10th_percentile":48.96,"90th_percentile":3084.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"569","median_amount":186.51,"10th_percentile":61.73,"90th_percentile":486.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"263","median_amount":288.42,"10th_percentile":97.02,"90th_percentile":563.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Mammography Services","code_information":[{"code":"N804","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"59","median_amount":92.66,"10th_percentile":87.61,"90th_percentile":92.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Coventry/Non Gatekeeper Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72.8] [OP Surgery  (%BC): 72.8] [Observation (%BC): 72.8] [Emergency Department (%BC): 72.8] [Occupational Therapy (%BC): 72.8] [Physical Therapy (%BC): 72.8] [Respiratory Services/Therapy  (%BC): 72.8] [Speech Therapy (%BC): 72.8] [All Other OP (%BC): 72.8]","count":"1 through 10","median_amount":480.11,"10th_percentile":479.55,"90th_percentile":480.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70.85] [OP Surgery  (%BC): 70.85] [Observation (%BC): 70.85] [Emergency Department (%BC): 70.85] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85]","count":"709","median_amount":499.49,"10th_percentile":499.49,"90th_percentile":528.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"40","median_amount":92.66,"10th_percentile":87.61,"90th_percentile":92.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"21","median_amount":535.8,"10th_percentile":525.16,"90th_percentile":535.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 71.54 Maximum Reimbursement 48190] [Cardiac Cath (%BC): 71.54 Maximum Reimbursement 54213] [Observation (%BC): 71.54 Maximum Reimbursement 15662] [Emergency Department (%BC): 71.54 Maximum Reimbursement 15662] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85 Charge Threshold 60000 (%BC): 70.85]","count":"35","median_amount":499.49,"10th_percentile":498.9,"90th_percentile":499.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"180","median_amount":498.44,"10th_percentile":497.52,"90th_percentile":498.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"50","median_amount":539.33,"10th_percentile":498.44,"90th_percentile":539.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"132","median_amount":94.46,"10th_percentile":89.32,"90th_percentile":94.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":101.05,"10th_percentile":101.05,"90th_percentile":101.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"39","median_amount":88.96,"10th_percentile":87.61,"90th_percentile":92.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":250.0,"10th_percentile":250.0,"90th_percentile":542.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"127","median_amount":599.25,"10th_percentile":587.35,"90th_percentile":599.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"212","median_amount":105.09,"10th_percentile":101.06,"90th_percentile":108.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"24","median_amount":103.11,"10th_percentile":103.11,"90th_percentile":103.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Non-covered Services","code_information":[{"code":"N900","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":92.66,"10th_percentile":88.96,"90th_percentile":92.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Coventry/Non Gatekeeper Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72.8] [OP Surgery  (%BC): 72.8] [Observation (%BC): 72.8] [Emergency Department (%BC): 72.8] [Occupational Therapy (%BC): 72.8] [Physical Therapy (%BC): 72.8] [Respiratory Services/Therapy  (%BC): 72.8] [Speech Therapy (%BC): 72.8] [All Other OP (%BC): 72.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70.85] [OP Surgery  (%BC): 70.85] [Observation (%BC): 70.85] [Emergency Department (%BC): 70.85] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85]","count":"29","median_amount":476.04,"10th_percentile":332.63,"90th_percentile":815.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":92.66,"10th_percentile":92.66,"90th_percentile":92.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 71.54 Maximum Reimbursement 48190] [Cardiac Cath (%BC): 71.54 Maximum Reimbursement 54213] [Observation (%BC): 71.54 Maximum Reimbursement 15662] [Emergency Department (%BC): 71.54 Maximum Reimbursement 15662] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85 Charge Threshold 60000 (%BC): 70.85]","count":"1 through 10","median_amount":389.68,"10th_percentile":389.68,"90th_percentile":389.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":388.85,"10th_percentile":388.85,"90th_percentile":782.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":674.43,"10th_percentile":674.43,"90th_percentile":674.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":94.46,"10th_percentile":94.46,"90th_percentile":94.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":92.66,"10th_percentile":92.66,"90th_percentile":92.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":50.0,"10th_percentile":50.0,"90th_percentile":50.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"1 through 10","median_amount":831.55,"10th_percentile":467.5,"90th_percentile":936.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"11","median_amount":95.36,"10th_percentile":93.53,"90th_percentile":146.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":144.89,"10th_percentile":144.89,"90th_percentile":144.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Packaged Services","code_information":[{"code":"N902","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Coventry/Non Gatekeeper Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72.8] [OP Surgery  (%BC): 72.8] [Observation (%BC): 72.8] [Emergency Department (%BC): 72.8] [Occupational Therapy (%BC): 72.8] [Physical Therapy (%BC): 72.8] [Respiratory Services/Therapy  (%BC): 72.8] [Speech Therapy (%BC): 72.8] [All Other OP (%BC): 72.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70.85] [OP Surgery  (%BC): 70.85] [Observation (%BC): 70.85] [Emergency Department (%BC): 70.85] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85]","count":"1 through 10","median_amount":180.0,"10th_percentile":180.0,"90th_percentile":180.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Community Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 71.54 Maximum Reimbursement 48190] [Cardiac Cath (%BC): 71.54 Maximum Reimbursement 54213] [Observation (%BC): 71.54 Maximum Reimbursement 15662] [Emergency Department (%BC): 71.54 Maximum Reimbursement 15662] [Occupational Therapy (%BC): 70.85] [Physical Therapy (%BC): 70.85] [Respiratory Services/Therapy  (%BC): 70.85] [Speech Therapy (%BC): 70.85] [All Other OP (%BC): 70.85 Charge Threshold 60000 (%BC): 70.85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Open Access Hmo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthlink","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76.5] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Youth Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Dual Eligible Medicare/Medicaid","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Mine Works Of America","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"1 through 10","median_amount":306.0,"10th_percentile":306.0,"90th_percentile":306.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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